0000883984-12-000085.txt : 20120810 0000883984-12-000085.hdr.sgml : 20120810 20120810171816 ACCESSION NUMBER: 0000883984-12-000085 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120810 FILED AS OF DATE: 20120810 DATE AS OF CHANGE: 20120810 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KOVALCHIK MICHAEL T CENTRAL INDEX KEY: 0001073390 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34634 FILM NUMBER: 121025327 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 X0306 4 2012-08-10 0 0000883984 ICU MEDICAL INC/DE ICUI 0001073390 KOVALCHIK MICHAEL T 951 CALLE AMANECER SAN CLEMENTE CA 92673 1 0 0 0 Common Stock 2012-08-10 4 X 0 1125.0 27.45 A 3887.0 D Common Stock 2012-08-10 4 S 0 1125.0 55.0 D 2762.0 D Common Stock 2012-08-10 4 X 0 1125.0 24.17 A 3887.0 D Common Stock 2012-08-10 4 S 0 1125.0 55.0 D 2762.0 D Common Stock 2012-08-10 4 X 0 4000.0 35.0 A 6762.0 D Common Stock 2012-08-10 4 S 0 4000.0 55.0 D 2762.0 D Non-Qualified Stock Option (right to buy) 24.17 2012-08-10 4 X 0 1125.0 D 2012-04-21 2018-04-21 Common Stock 1125.0 0.0 D Non-Qualified Stock Option (right to buy) 27.45 2012-08-10 4 X 0 1125.0 D 2012-07-21 2018-07-21 Common Stock 1125.0 0.0 D Non-Qualified Stock Option (right to buy) 35.0 2012-08-10 4 X 0 4000.0 D 2011-08-14 2017-08-14 Common Stock 4000.0 4500.0 D The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 Trading Plan adopted by the reporting person on April 19, 2012. Transaction is the exercise of a derivative security; see Column 2. By: Lynn DeMartini For: Michael T. Kovalchik, III, M.D. 2012-08-10