Keenan Timothy J Form 5 FULLER H B / Timothy J Keenan ownership change

SEC Form 5

FORM 5

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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).

Form 3 Holdings Reported.

Form 4 Transactions Reported.

1. Name and Address of Reporting Person^*

Keenan Timothy J

(Last)

(First)

(Middle)

1200 WILLOW LAKE BOULEVARD

P.O. BOX 64683

(Street)

ST. PAUL

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. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/01/2018

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 at end of Issuer's Fiscal Year (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
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)	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	08/01/2018		G	20	D	$0.0000⁽¹⁾	22,940	D
Common Stock	08/01/2018		G	90	D	$0.0000⁽¹⁾	22,850	D
Common Stock	08/02/2018		G	30	D	$0.0000⁽²⁾	22,820	D
Common Stock							5.72⁽³⁾	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)
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)	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Employee Stock Option (Right-to-Buy)	$20.57						12/03/2010⁽⁴⁾	12/03/2019	Common Stock	13,205		13,205	D
Employee Stock Option (Right-to-Buy)	$22.27						01/20/2012⁽⁴⁾	01/20/2021	Common Stock	15,822		15,822	D
Employee Stock Option (Right-to-Buy)	$28.4						01/26/2013⁽⁴⁾	01/26/2022	Common Stock	14,278		14,278	D
Employee Stock Option (Right-to-Buy)	$33.38						01/19/2017⁽⁵⁾	01/19/2026	Common Stock	16,408		16,408	D
Employee Stock Option (Right-to-Buy)	$39.64						01/24/2014⁽⁴⁾	01/24/2023	Common Stock	10,291		10,291	D
Employee Stock Option (Right-to-Buy)	$41						01/22/2016⁽⁴⁾	01/22/2025	Common Stock	12,534		12,534	D
Employee Stock Option (Right-to-Buy)	$48.92						01/23/2015⁽⁴⁾	01/23/2024	Common Stock	9,154		9,154	D
Employee Stock Option (Right-to-Buy)	$51.1						01/26/2018⁽⁵⁾	01/26/2027	Common Stock	14,336		14,336	D
Employee Stock Option (Right-to-Buy)	$53.57						01/25/2019⁽⁵⁾	01/25/2028	Common Stock	13,100		13,100	D
Performance Stock Option (Right-to-Buy)	$57.7						01/31/2021⁽⁶⁾	10/20/2027	Common Stock	34,403		34,403	D
Performance Stock Units	$0.0000⁽⁷⁾						01/19/2017⁽⁸⁾	01/19/2019	Common Stock	659.24		659.24⁽⁹⁾	D
Performance Stock Units	$0.0000⁽¹⁰⁾						01/25/2019⁽⁸⁾	01/25/2021	Common Stock	1,396.58		1,396.58	D
Performance Stock Units	$0.0000⁽⁷⁾						01/26/2018⁽⁸⁾	01/26/2020	Common Stock	1,054.01		1,054.01⁽⁹⁾	D
Restricted Stock Units	$0.0000⁽¹¹⁾						01/19/2017⁽¹²⁾	01/19/2019	Common Stock	663.32		663.32⁽¹³⁾	D
Restricted Stock Units	$0.0000⁽¹¹⁾						01/25/2019⁽¹²⁾	01/25/2021	Common Stock	1,396.58		1,396.58	D
Restricted Stock Units	$0.0000⁽¹¹⁾						01/26/2018⁽¹²⁾	01/26/2020	Common Stock	2,299.43		2,299.43⁽¹³⁾	D

Explanation of Responses:

1. Bona fide gift made by the Reporting Person on August 1, 2018.

2. Bona fide gift made by the Reporting Person on August 2, 2018.

3. Amount includes shares and dividends acquired pursuant to the H.B.Fuller Company 401(k) & Retirement Plan.

4. This option is 100% vested.

5. This option vests in three equal annual installments beginning on the date shown.

6. These performance-based non-qualified stock options vest on the date shown contingent upon H.B. Fuller achieving adjusted EBITDA at least at the threshold level of performance.

7. These performance stock units convert into shares of common stock on a 1-for-1 basis.

8. These performance stock units vest in three equal 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.

9. 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.

10. These performance stock units convert into shares of common stock on a 1-for-1 basis

11. These restricted stock units convert into shares of common stock on a 1-for-1 basis.

12. These restricted stock units vest in three equal annual installments beginning on the date shown.

13. Amount includes restricted stock units acquired pursuant to a dividend equivalent reinvestment feature.

	/s/ Timothy J. Keenan	12/14/2018
	** 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 4 (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.
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Keenan Timothy J Form 5FULLER H B / Timothy J Keenan ownership change