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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 | $ 0 (3) | 12/03/2009 | A | 3,840 (4) | (5) | 12/03/2012 | Common Stock | 3,840 | $ 0 (3) | 3,840 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MCCREARY JAMES C 1200 WILLOW LAKE BOULEVARD P.O. BOX 64683 ST. PAUL, MN 55164-0683 |
VP and Corp. Controller |
/s/ Timothy J. Keenan, Attorney-in-Fact | 01/27/2010 | |
**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) | Amended and Restated 2000 Stock Incentive Plan: 8,506 restricted shares were awarded pursuant to H.B. Fuller Company's Amended and Restated 2000 Stock Incentive Plan. This amount includes 2,499 restricted shares that will vest effective December 4, 2009; 2,134 restricted shares that will vest effective December 6, 2010; and 3,873 restricted shares that will vest effective December 4, 2011. Amount also includes restricted shares acquired pursuant to a dividend accrual feature of the Amended and restated 2000 Stock Incentive Plan. |
(2) | This amount has been amended to reflect the reversal of 3,840 shares of restricted stock that were originally reported in error on 12/3/2009. The acquisition of 3,840 restricted stock units has been moved to Table II. |
(3) | Amended and Restated 2000 Stock Incentive Plan: These restricted stock units convert into shares of common stock on a 1-for-1 basis. |
(4) | This amount was originally reported in error on Table I as restricted stock and has been moved to Table II. |
(5) | Amended and Restated 2000 Stock Incentive Plan: These restricted stock units vest in three equal annual installments beginning on December 3, 2010. |
Remarks: This amendment is being filed on behalf of Mr. McCreary to correct original Form 4 filed on 12/7/2009. On December 3, 2009, Mr. McCreary was awarded 3,840 restricted stock units, not restricted stock as originally reported on Table I. This error also affected 5 subsequent Form 4 filings submitted on behalf of Mr. McCreary on 12/8/2009, 12/14/2009, 12/28/2009, 1/11/2010 and 1/25/2010. |