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)
| 2. Date of Event Requiring Statement (Month/Day/Year) 03/16/2016 | 3. Issuer Name and Ticker or Trading Symbol ORTHOFIX INTERNATIONAL N V [ OFIX ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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 | 25,367(1) | 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 Option | (2) | 08/01/2023 | Common Stock | 10,000 | 22.75 | D | |
Stock Option | (3) | 09/26/2023 | Common Stock | 8,750 | 21.78 | D | |
Stock Option | (4) | 06/30/2024 | Common Stock | 4,425 | 36.25 | D | |
Stock Option | (5) | 06/30/2025 | Common Stock | 4,425 | 33.12 | D |
Explanation of Responses: |
1. Represents (i) 10,949 shares directly owned; (ii) 8,518 time-based restricted stock awards in which 3,707 shares, 3,706 shares, 737 shares and 368 shares will vest in the remainder of 2016, 2017, 2018 and 2019 respectively; and (iii) 5,900 performance-based restricted stock awards of 2,950 shares granted under both the 2014 Performance Vesting Restricted Stock Grant Agreement and the 2015 Performance Vesting Restricted Stock and Performance Share Unit Grant Agreement. |
2. These stock options vest in 25% increments on the first, second, third and fourth anniversaries of the grant date, August 1, 2013. |
3. These stock options vest in 25% increments on the first, second, third and fourth anniversaries of the grant date, September 26, 2013. |
4. These stock options vest in 25% increments on the first, second, third and fourth anniversaries of the grant date, June 30, 2014. |
5. These stock options vest in 25% increments on the first, second, third and fourth anniversaries of the grant date, June 30, 2015. |
Remarks: |
/s/ Jeffrey M. Schumm, by power of attorney | 03/21/2016 | |
** 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. |