FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/07/2014 |
3. Issuer Name and Ticker or Trading Symbol
Xylem Inc. [ XYL ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 8,976(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option (Right to Buy) | 11/07/2014 | 11/07/2021 | Common Stock | 1,790 | $24.6 | D | |
Stock Option (Right to Buy) | (2) | 03/01/2023 | Common Stock | 5,494 | $27.49 | D | |
Stock Option (Right to Buy) | (3) | 02/25/2024 | Common Stock | 6,807 | $38.76 | D |
Explanation of Responses: |
1. Reflects Resrticted Stock Units scheduled to vest as follows: 1,707 on November 7, 2014; 3,383 on March 2, 2015; 2,183 on March 1, 2016; and 1,703 on February 25, 2017. |
2. 5494 options will vest in two equal parts on March 1, 2015 and March 1, 2016. |
3. 6807 options vest in three equal parts on February 25, 2016, February 25, 2016 and February 25, 2017. |
Remarks: |
Please see attached POA on Exhibit 24. |
/s/ Hannah Skeete, Securities Counsel Xylem Inc., by power of attorney for Tomas Brannemo | 05/14/2014 | |
** 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 5 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |