SEC Form 3
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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
JENSEN TRACI L

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

(Street)
ST. PAUL MN 55164-0683

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/01/2011
3. Issuer Name and Ticker or Trading Symbol
FULLER H B CO [ FUL ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP, Americas Adhesives
5. 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 Beneficially Owned
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 12,034.979(1) D
Common Stock 231.1997(2) I By 401(k) Plan
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Employee Stock Option (Right-to-Buy) (3) 01/21/2019 Common Stock 7,640 $13.75 D
Employee Stock Option (Right-to-Buy) (4) 12/03/2019 Common Stock 4,629 $20.57 D
Employee Stock Option (Right-to-Buy) (5) 01/20/2021 Common Stock 12,658 $22.27 D
Employee Stock Option (Right-to-Buy) (6) 04/14/2020 Common Stock 6,223 $23.68 D
Explanation of Responses:
1. Amended and Restated 2000 Stock Incentive Plan: 11,488 restricted shares were awarded pursuant to H.B. Fuller Company's Amended and Restated 2000 Stock Incentive Plan. This amount includes 1,760 restricted shares that will vest effective January 21, 2012; 1,920 restricted shares that will vest in three equal annual installments beginning on December 3, 2010; 2,580 restricted shares that will vest in three equal annual installments beginning on April 14, 2011; and 5,228 restricted shares that will vest in three equal annual installments beginning January 20, 2012. Total amount also includes restricted shares acquired pursuant to a dividend accrual feature of the Amended and Restated 2000 Stock Incentive Plan.
2. 401(k) Plan: This amount includes shares and dividends acquired pursuant to the H.B. Fuller Company 401(k) & Retirement Plan.
3. Amended and Restated 2000 Stock Incentive Plan: This option vests in four equal annual installments beginning on January 21, 2010.
4. Amended and Restated 2000 Stock Incentive Plan: This option vests in three equal annual installments beginning on December 3, 2010.
5. Amended and Restated 2000 Stock Incentive Plan: This option vests in three equal annual installments beginning on January 20, 2012.
6. Amended and Restated 2000 Stock Incentive Plan: This option vests in three equal annual installments beginning on April 14, 2011.
Remarks:
jesnen-poa.txt
/s/ Debra L. Hovland, Attorney-in-Fact 11/10/2011
** 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.