SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/17/2024 |
3. Issuer Name and Ticker or Trading Symbol
Xylem Inc. [ XYL ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 2,139(1) | D | |
Common Stock | 9,488(2) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Options (Right to buy) | (3) | 03/01/2034 | Common Stock | 3,305 | 127.94 | D | |
Stock Options (Right to buy) | (4) | 03/01/2031 | Common Stock | 3,233 | 102.23 | D | |
Stock Options (Right to buy) | (5) | 03/01/2033 | Common Stock | 4,301 | 101.09 | D | |
Stock Options (Right to buy) | (6) | 03/01/2032 | Common Stock | 4,406 | 86.76 | D | |
Stock Options (Right to buy) | (7) | 02/27/2030 | Common Stock | 3,509 | 80.66 | D | |
Stock Options (Right to buy) | (8) | 02/21/2028 | Common Stock | 2,182 | 75.18 | D | |
Stock Options (Right to buy) | (9) | 02/20/2029 | Common Stock | 2,655 | 74.07 | D |
Explanation of Responses: |
1. Reflects restricted stock units which are scheduled to vest as follows: 1074 on March 1, 2025, 739 on March 1, 2026, 326 on March 1, 2027. Each restricted stock unit represents the right to receive one share of common stock upon vesting. |
2. Reflects common stock incident to previous vestings of restricted stock units. |
3. These options are scheduled to vest in one-third increments on March 1, 2025, March 1, 2026 and March 1, 2027. |
4. 3,233 options are fully vested and exercisable. |
5. 1,433 options are fully vested and exercisable, 1,434 are scheduled to vest on March 1, 2025 and 1,434 are scheduled to vest on March 1, 2026. |
6. 2,938 options are fully vested and exercisable, 1,468 are scheduled to vest on March 1, 2025. |
7. 3,509 options are fully vested and exercisable. |
8. 2,182 options are fully vested and exercisable. |
9. 2,655 options are fully vested and exercisable. |
Remarks: |
/s/ Seaneen Cline, by power of attorney for Albert Cho | 05/29/2024 | |
** 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 5 (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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |