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*
Keenan Timothy J

(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)
VP, Gen. Counsel & Corp. Sec.
3. Date of Earliest Transaction (Month/Day/Year)
01/31/2017
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 01/31/2017 M 1,701 A $0.0000(1) 24,804 D
Common Stock 01/31/2017 F 532(2) D $49.37 24,272(3) D
Common Stock 5.59(4) I By 401(k) Plan
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
Phantom Units $0.0000(5) 01/31/2017 M 1,701 (6) (6) Common Stock 1,701 $0.0000(5) 0.0000 D
Employee Stock Option (Right-to-Buy) $14.15 (7) 12/04/2018 Common Stock 13,000 13,000 D
Employee Stock Option (Right-to-Buy) $20.57 (7) 12/03/2019 Common Stock 17,505 17,505 D
Employee Stock Option (Right-to-Buy) $22.27 (7) 01/20/2021 Common Stock 15,822 15,822 D
Employee Stock Option (Right-to-Buy) $28.4 (7) 01/26/2022 Common Stock 14,278 14,278 D
Employee Stock Option (Right-to-Buy) $33.38 (8) 01/19/2026 Common Stock 16,408 16,408 D
Employee Stock Option (Right-to-Buy) $39.64 (7) 01/24/2023 Common Stock 10,291 10,291 D
Employee Stock Option (Right-to-Buy) $41 (9) 01/22/2025 Common Stock 12,534 12,534 D
Employee Stock Option (Right-to-Buy) $48.92 (10) 01/23/2024 Common Stock 9,154 9,154 D
Employee Stock Option (Right-to-Buy) $51.1 01/26/2018(11) 01/26/2027 Common Stock 14,336 14,336 D
Performance Stock Units $0.0000(12) 01/19/2017(13) 01/19/2019 Common Stock 1,272.91 1,272.91(14) D
Performance Stock Units $0.0000(15) 01/26/2018(16) 01/26/2020 Common Stock 1,537 1,537 D
Restricted Stock Units $0.0000(17) (18) 01/19/2019 Common Stock 1,274.94 1,274.94(19) D
Restricted Stock Units $0.0000(17) (20) 01/22/2018 Common Stock 1,115.51 1,115.51(19) D
Restricted Stock Units $0.0000(21) 01/26/2018(22) 01/26/2020 Common Stock 3,351 3,351 D
Explanation of Responses:
1. On January 31, 2017, the reporting person constructively received 1,701 shares of H.B. Fuller common stock in settlement of an equal number of units held pursuant to the Key Employee Deferred Compensation Plan.
2. Shares withheld for taxes due on 1,701 shares issued on January 31, 2017 pursuant to the Key Employee Deferred Compensation Plan.
3. Amended and Restated Year 2000 Stock Incentive Plan: Amount includes 27,973 restricted shares awarded pursuant to H.B. Fuller Company's Amended and Restated Year 2000 Stock Incentive Plan and are 100% vested. Amount also includes restricted shares acquired pursuant to a dividend accrual feature of the Amended and Restated Year 2000 Stock Incentive Plan.
4. 401(k) Plan: This amount includes shares and dividends acquired pursuant to the H.B.Fuller Company 401(k) & Retirement Plan.
5. Deferred Compensation Plan: These units (acquired after 12-31-04) convert into shares of common stock on a 1-for-1 basis.
6. Deferred Compensation Plan: These units (acquired after 12-31-04) convert into shares of common stock upon the earlier of certain termination events as specified in the Key Employee Deferred Compensation Plan or such earlier date as selected by the participant, subject to holding periods required by law.
7. Amended and Restated Year 2000 Stock Incentive Plan: This option is 100% vested.
8. 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.
9. H.B. Fuller Company 2013 Master Incentive Plan: This option vests in three equal annual installments beginning on January 22, 2016.
10. 2013 Master Incentive Plan: This option vests are 100% vested.
11. H.B. Fuller Company 2016 Master Incentive Plan: This option vests in three equal installments beginning on the date shown.
12. H.B. Fuller Company 2013 Master Incentive Plan: These performance stock units convert into shares of common stock on a 1-for-1 basis.
13. H.B. Fuller Company 2013 Master Incentive Plan: These performance stock units vest in three annual installments beginning on the date shown 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 performance stock units make up part of the reporting person's fiscal year 2016 long-term incentive plan grant.
14. H.B. Fuller Company 2013 Master Incentive Plan: This amount has been adjusted to reflect the increase in number of performance stock units of the original grant based on performance criteria. Amount also includes performance stock units acquired pursuant to a dividend equivalent reinvestment feature of the H.B. Fuller Company 2013 Master Incentive Plan.
15. H.B. Fuller Company 2016 Master Incentive Plan: These performance stock units convert into shares of common stock on a 1-for-1 basis.
16. H.B. Fuller Company 2016 Master Incentive Plan: These performance stock units vest in three annual installments beginning on the date shown 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.
17. H.B. Fuller Company 2013 Master Incentive Plan: These restricted stock units convert into shares of common stock on a 1-for-1 basis.
18. H.B. Fuller Company 2013 Master Incentive Plan: These restricted stock units vest in three equal annual installments beginning on January 19, 2017. These restricted stock units make up part of the reporting person's fiscal year 2016 long-term incentive plan grant.
19. H.B. Fuller Company 2013 Master Incentive Plan: These restricted units include stock units acquired pursuant to a dividend equivalent reinvestment feature of the H.B. Fuller Company 2013 Master Incentive Plan.
20. H.B. Fuller Company 2013 Master Incentive Plan: These restricted stock units vest in three equal annual installments beginning on January 22, 2016.
21. H.B. Fuller Company 2016 Master Incentive Plan: These restricted stock units convert into shares of common stock on a 1-for-1 basis.
22. H.B. Fuller Company 2016 Master Incentive Plan: These restricted stock units vest in three equal annual installments beginning on the date shown.
/s/ Timothy J. Keenan 02/02/2017
** Signature of Reporting Person Date
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