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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 | ||||||||
2013 Director RSU Award | $ 0 | 04/29/2016(1) | M | 1,015 (2) | 05/01/2014 | 05/01/2016 | Common Stock | 1,015 | $ 0 | 0 | D | ||||
2014 Director RSU Award | $ 0 | 04/29/2016(1) | M | 859 (3) | 05/01/2015 | 05/01/2017 | Common Stock | 859 | $ 0 | 859 | D | ||||
2015 Director RSU Award | $ 0 | 04/29/2016(1) | M | 746 (4) | 05/01/2016 | 05/01/2018 | Common Stock | 746 | $ 0 | 1,493 | D | ||||
2016 Director RSU Award | $ 0 | 05/01/2016(5) | A | 1,922 (6) | 05/01/2017 | 05/01/2019 | Common Stock | 1,922 | $ 0 | 1,922 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Siewert Patrick 207 GOODE AVENUE GLENDALE, CA 91203 |
X |
/s/ Erica Perry POA for Patrick Siewert | 05/02/2016 | |
**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) | Because the vesting date of the restricted stock units fell on a weekend, they vested on April 29, 2016, the last trading day prior to the vesting date. |
(2) | Shares reflect the vesting of the third tranche of restricted stock units granted on May 1, 2013. |
(3) | Shares reflect the vesting of the second tranche of restricted stock units granted on May 1, 2014. |
(4) | Shares reflect the vesting of the first tranche of restricted stock units granted on May 1, 2015. |
(5) | Because the grant date of the restricted stock units fell on a weekend, the grant date fair market value was based on April 29, 2016, the last trading day prior to the grant date. |
(6) | The restricted stock units vest in three cumulative installments on the first, second and third anniversaries of the date of grant. Each restricted stock unit represents a contingent right to receive one share of Avery Dennison Corporation common stock. |