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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 | ||||||||
Restricted Stock Units | (2) | 11/09/2006 | M | 100,000 | (1) | (1) | Common Stock | 100,000 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DEKKERS MARIJN E 81 WYMAN STREET P.O. BOX 9046 WALTHAM, MA 024549046 |
X | Chief Executive Officer |
By: Barbara J. Lucas, Attorney-in-Fact for Marijn E. Dekkers | 03/03/2008 | |
**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) | The Reporting Person received a restricted stock unit grant on November 21, 2002, which was reported as a derivative security in Table II of a Form 4 filed on November 22, 2002. The grant provided that no common stock was to be delivered with respect to the grant until the termination of the employment of the Reporting Person. The grant also provided for distribution of the shares immediately before a Change in Control. The merger of the Issuer with Fisher Scientific International Inc. on November 9, 2006 constituted a Change in Control of the Issuer; however, the distribution of shares was inadvertently overlooked until the Issuer's discovery of this oversight in 2008, and the shares were delivered to the Reporting Person on February 28, 2008. |
(2) | 1 for 1 |