0000883984-11-000096.txt : 20111122 0000883984-11-000096.hdr.sgml : 20111122 20111122172322 ACCESSION NUMBER: 0000883984-11-000096 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111122 FILED AS OF DATE: 20111122 DATE AS OF CHANGE: 20111122 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: COSTELLO RICHARD A CENTRAL INDEX KEY: 0001073401 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34634 FILM NUMBER: 111222704 MAIL ADDRESS: STREET 1: C/O ICU MEDICAL INC STREET 2: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ICU MEDICAL INC/DE CENTRAL INDEX KEY: 0000883984 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 330022692 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92763-6212 BUSINESS PHONE: 949-366-2183 MAIL ADDRESS: STREET 1: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92763-6212 4 1 edgardoc.xml PRIMARY DOCUMENT X0304 4 2011-11-22 0 0000883984 ICU MEDICAL INC/DE ICUI 0001073401 COSTELLO RICHARD A 951 CALLE AMANECER SAN CLEMENTE CA 92673 0 1 0 0 Vice President Sales Common Stock 2011-11-22 2011-11-22 4 X 0 5000.0 31.195 A 5000.0 D Common Stock 2011-11-22 2011-11-22 4 S 0 5000.0 42.0 D 0.0 D Non-Qualified Stock Option (right to buy) 31.195 2011-11-22 2011-11-22 4 X 0 5000.0 D 2004-11-16 2015-04-16 Common Stock 5000.0 5000.0 D Transaction is the exercise of a derivative security; see Column 2. By: Lynn DeMartini For: Richard A. Costello 2011-11-22