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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Petrovic Shacey C/O INSULET CORPORATION 100 NAGOG PARK ACTON, MA 01720 |
X | President and CEO |
/s/ David Colleran, attorney-in-fact | 02/26/2019 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | This transaction represents the withholding of shares received upon the vesting of restricted stock units to cover the associated tax obligations. |
(2) | Includes 4,508 restricted stock units granted on February 22, 2017, which vest on February 22, 2020; 7,120 restricted stock units granted on February 24, 2016, which vest on February 24, 2019; 8,544 performance share units granted on February 24, 2016, which vest on February 24, 2019; 4,474 restricted stock units granted on February 14, 2018, which vest as to one-half of the total units on February 14, 2020 and one-half of the total units on February 14, 2021; and 6,809 restricted stock units granted on January 2, 2019, which vest as to one-third of the total units on January 2, 2020, and one-third of the total units on January 2, 2021, and one-third of the total units on January 2, 2022, subject to continued employment. Vested shares will be delivered to the reporting person as soon as practicable following a vesting date. |
(3) | Includes 4,508 restricted stock units granted on February 22, 2017, which vest on February 22, 2020; 4,474 restricted stock units granted on February 14, 2018, which vest as to one-half of the total units on February 14, 2020 and one-half of the total units on February 14, 2021; and 6,809 restricted stock units granted on January 2, 2019, which vest as to one-third of the total units on January 2, 2020, and one-third of the total units on January 2, 2021, and one-third of the total units on January 2, 2022, subject to continued employment. Vested shares will be delivered to the reporting person as soon as practicable following a vesting date. |