SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Owens James

(Last) (First) (Middle)
1200 WILLOW LAKE BOULEVARD
P.O. BOX 64683

(Street)
ST. PAUL MN 55164-0683

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FULLER H B CO [ FUL ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
3. Date of Earliest Transaction (Month/Day/Year)
01/22/2016
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 01/22/2016 M 9,619 A $34.72 161,283.366 D
Common Stock 01/22/2016 F 3,335(1) D $34.72 157,948.366 D
Common Stock 01/23/2016 M 7,855 A $34.72 165,803.366 D
Common Stock 01/23/2016 F 2,641(2) D $34.72 163,162.366 D
Common Stock 01/24/2016 F 23,615(3) D $34.72 139,547.366(4) D
Common Stock 337.82(5) I By 401(k) Plan
Common Stock 280 I By Son(6)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Restricted Stock Units $0.0000(7) 01/22/2016 M 9,619 (8) 01/22/2018 Common Stock 9,619 $34.72 19,532.52(9) D
Restricted Stock Units $0.0000(7) 01/23/2016 M 7,855 (10) 01/23/2017 Common Stock 7,855 $34.72 8,093.69(9) D
Employee Stock Option (Right-to-Buy) $33.38 (11) 01/19/2026 Common Stock 182,039 182,039 D
Employee Stock Option (Right-to-Buy) $22.27 (12) 01/20/2021 Common Stock 48,331 48,331 D
Employee Stock Option (Right-to-Buy) $41 (8) 01/22/2025 Common Stock 112,727 112,727 D
Employee Stock Option (Right-to-Buy) $48.92 (13) 01/23/2024 Common Stock 79,061 79,061 D
Employee Stock Option (Right-to-Buy) $39.64 (12) 01/24/2023 Common Stock 80,697 80,697 D
Employee Stock Option (Right-to-Buy) $28.4 (12) 01/26/2022 Common Stock 77,881 77,881 D
Employee Stock Option (Right-to-Buy) $25.19 (12) 07/07/2021 Common Stock 15,748 15,748 D
Employee Stock Option (Right-to-Buy) $19.03 (12) 10/02/2018 Common Stock 7,385 7,385 D
Employee Stock Option (Right-to-Buy) $20.57 (12) 12/03/2019 Common Stock 33,275 33,275 D
Employee Stock Option (Right-to-Buy) $14.15 (12) 12/04/2018 Common Stock 47,663 47,663 D
Restricted Stock Units $0.0000(7) (14) (15) Common Stock 20,823 20,823 D
Restricted Stock Units $0.0000(7) (16) 01/19/2019 Common Stock 20,823 20,823 D
Explanation of Responses:
1. Shares withheld for taxes due on 9,619 shares issued pursuant to the H.B. Fuller Company 2013 Master Stock Incentive Plan.
2. Shares withheld for taxes due on 7,855 shares issued pursuant to the H.B. Fuller Company 2013 Master Stock Incentive Plan.
3. Shares withheld for taxes due on 48,992 shares issued pursuant to the Amended and Restated Year 2000 Stock Incentive Plan.
4. Amended and Restated Year 2000 Stock Incentive Plan: 189,261 restricted shares were awarded. Amount includes (i) 26,625 restricted shares that are 100% vested; (ii) 6,502 restricted shares that vested in three equal installments beginning on July 7, 2012; and (iii) subject to one or more performance measures being achieved, (a) 19,961 restricted shares that vested in three equal installments beginning on January 20, 2012; (b) 31,472 restricted shares that vested in three equal installments beginning on January 26, 2013; (c) 30,794 restricted shares that vested in three equal annual installments beginning on January 24, 2014; and (d) 73,907 restricted shares (50% of these shares vested on January 24, 2016 and 50% will vest on January 24, 2017). Total amount also includes restricted shares acquired pursuant to a dividend accrual feature of the Amended and Restated Year 2000 Stock Incentive Plan.
5. 401(k) Plan: This amount includes shares and dividends acquired pursuant to the H.B.Fuller Company 401(k) & Retirement Plan.
6. Held jointly by spouse and son.
7. H.B. Fuller Company 2013 Master Incentive Plan: These restricted stock units convert into shares of common stock on a 1-for-1 basis.
8. H.B. Fuller Company 2013 Master Incentive Plan: These restricted stock units vest in three equal annual installments beginning on January 22, 2016.
9. H.B. Fuller Company 2013 Master Incentive Plan: These restricted units include stock units acquired pursuant to a dividend equivalent reinvestment feature of H.B. Fuller Company's Amended and Restated Year 2000 Stock Incentive Plan.
10. H.B. Fuller Company 2013 Master Incentive Plan: These restricted stock units vest in three equal annual installments beginning on January 23, 2015, subject to one or more performance measures being achieved.
11. H.B. Fuller Company 2013 Master Incentive Plan: This option vests in three equal installments beginning on January 19, 2017. This option makes up part of the reporting person's fiscal year 2016 long-term incentive plan grant.
12. Amended and Restated Year 2000 Stock Incentive Plan: This option is 100% vested.
13. Amended and Restated Year 2000 Stock Incentive Plan: This option vests in three equal annual installments beginning on January 23, 2015.
14. H.B. Fuller Company 2013 Master Incentive Plan: These restricted stock units vest in three annual installments beginning on January 19, 2017 upon H.B. Fuller achieving return on invested capital at least at the threshold level of performance in each year of the three years of vesting. These restricted stock units make up part of the reporting person's fiscal year 2016 long-term incentive plan grant.
15. These restricted stock units expire on January 19, 2019.
16. H.B. Fuller Company 2013 Master Incentive Plan: These restricted stock units vest in three equal annual installments beginning on January 19, 2017, subject to one or more performance measures being achieved. These restricted stock units make up part of the reporting person's fiscal year 2016 long-term incentive plan grant.
/s/ Timothy J. Keenan, Attorney-in-Fact 01/26/2016
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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