| 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) 07/27/2017 | 3. Issuer Name and Ticker or Trading Symbol LivaNova PLC [ LIVN ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 07/27/2017 | ||||||||||||||
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) |
| 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 | ||||
| Restricted Stock Units(1)(2) | 06/12/2018(3) | 06/12/2018 | Ordinary Shares | 1,147 | (3) | D | |
| Restricted Stock Units(1)(2) | 06/12/2019(3) | 06/12/2019 | Ordinary Shares | 1,146 | (3) | D | |
| Restricted Stock Units(1)(2) | 06/12/2020(3) | 06/12/2020 | Ordinary Shares | 1,146 | (3) | D | |
| Restricted Stock Units(1)(2) | 06/12/2021(3) | 06/12/2021 | Ordinary Shares | 1,146 | (3) | D | |
| Stock Appreciation Rights(1) | (4) | 06/12/2027 | Ordinary Shares | 15,203 | 59.97 | D | |
| Explanation of Responses: |
| 1. Due to an administrative error, LivaNova PLC (the "Company") failed to include on the original Form 3 certain derivative securities owned by reporting person as of June 12, 2017. This amended Form 3 is being filed to provide the omitted information. |
| 2. Each restricted stock unit (RSU) represents a contingent right to receive one ordinary share ("Ordinary Share") of the Company, GBP 1.00 par value, in accordance with the terms of the LivaNova PLC 2015 Incentive Award Plan (the "Plan") and the terms of the award agreement. |
| 3. On June 12, 2017, reporting person was granted RSUs subject to a four-year vesting schedule, vesting 25% on each of the first four anniversaries of the grant date subject to continued service during the vesting period and the terms of the award agreement. |
| 4. On June 12, 2017, reporting person was granted an award of stock appreciation rights ("SARs"). Subject to the terms and conditions of the Plan and the terms of the SAR Agreement, the SARs shall vest in equal installments of 25% on each of the four anniversaries of the grant date. |
| Remarks: |
| /s/ Sarah K. Mohr, POA | 01/17/2020 | |
| ** 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. | ||
