0001287151-18-000115.txt : 20181017 0001287151-18-000115.hdr.sgml : 20181017 20181017161011 ACCESSION NUMBER: 0001287151-18-000115 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181017 FILED AS OF DATE: 20181017 DATE AS OF CHANGE: 20181017 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: QUAIN MITCHELL I CENTRAL INDEX KEY: 0001213693 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32498 FILM NUMBER: 181126508 MAIL ADDRESS: STREET 1: THE ROYAL POINCIANA, APT. 307 STREET 2: 333 SUNSET AVENUE CITY: PALM BEACH STATE: FL ZIP: 33480 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: XERIUM TECHNOLOGIES INC CENTRAL INDEX KEY: 0001287151 STANDARD INDUSTRIAL CLASSIFICATION: BROADWOVEN FABRIC MILS, MAN MADE FIBER & SILK [2221] IRS NUMBER: 421558674 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 14101 CAPITAL BOULEVARD CITY: YOUNGSVILLE STATE: NC ZIP: 27596 BUSINESS PHONE: 919-526-1400 MAIL ADDRESS: STREET 1: 14101 CAPITAL BOULEVARD CITY: YOUNGSVILLE STATE: NC ZIP: 27596 4 1 wf-form4_153980699433120.xml FORM 4 X0306 4 2018-10-17 1 0001287151 XERIUM TECHNOLOGIES INC XRM 0001213693 QUAIN MITCHELL I C/O XERIUM TECHNOLOGIES, INC. 14101 CAPITAL BOULEVARD YOUNGSVILLE NC 27596 1 0 0 0 Common Stock 2018-10-17 4 D 0 22765 13.50 D 0 D Common Stock 2018-10-17 4 D 0 20502 13.50 D 0 I Via family trust Represents the conversion of outstanding shares of common stock of Xerium Technologies, Inc. (the "Company") and vested director deferred stock units into the right to receive $13.50 per share or unit in connection with the merger of the Company with an indirect wholly owned subsidiary of Andritz AG on October 17, 2018 (the "Merger"), pursuant to an Agreement and Plan of Merger dated June 24, 2018. Represents the conversion of outstanding shares of common stock of the Company into the right to receive $13.50 per share in connection with the Merger. /s/ Phillip Kennedy, by power of attorney 2018-10-17