SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Avery Dennison Corp [ AVY ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 02/23/2017 | ||||||||||||||||||||||||||
4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 02/23/2017 | M | 6,301 | A | $80.21 | 84,351 | D | |||
Common Stock | 02/23/2017 | F | 3,288 | D | $80.21 | 81,063 | D | |||
Common Stock | 02/23/2017 | M | 6,252 | A | $80.21 | 87,315 | D | |||
Common Stock | 02/23/2017 | F | 2,349 | D | $80.21 | 84,966 | D | |||
Common Stock | 02/23/2017 | M | 10,073 | A | $80.21 | 95,039 | D | |||
Common Stock | 02/23/2017 | F | 4,369 | D | $80.21 | 90,670 | D | |||
Common Stock | 02/23/2017 | M | 9,481 | A | $80.21 | 100,151 | D | |||
Common Stock | 02/23/2017 | F | 4,948 | D | $80.21 | 95,203 | D | |||
Common Stock | 02/23/2017 | M | 31,140 | A | $80.21 | 126,343 | D | |||
Common Stock | 02/23/2017 | F | 16,250 | D | $80.21 | 110,093 | D | |||
Common Stock (Savings Plan) | 3,691.0042 | I | Savings Plan |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
2013 MSU Award | $0 | 02/23/2017 | M | 6,301(1) | 02/27/2014 | 03/01/2017 | Common Stock | 6,301 | $0 | 0 | D | ||||
2014 MSU Award | $0 | 02/23/2017 | M | 6,252(2) | 02/26/2015 | 02/27/2018 | Common Stock | 6,252 | $0 | 3,725 | D | ||||
2015 MSU Award | $0 | 02/23/2017 | M | 10,073(3) | 02/26/2016 | 02/26/2019 | Common Stock | 10,073 | $0 | 12,572 | D | ||||
2016 MSU Award | $0 | 02/23/2017 | M | 9,481(4) | 02/25/2017 | 02/25/2020 | Common Stock | 9,481 | $0 | 22,627 | D | ||||
2014 PU Award | $0 | 02/23/2017 | M | 31,140(5) | 02/27/2017 | 02/27/2017 | Common Stock | 31,140 | $0 | 0 | D | ||||
2017 MSU Award | $0 | 02/23/2017 | A | 25,574(6) | 02/23/2018 | 02/23/2021 | Common Stock | 25,574 | $0 | 25,574 | D | ||||
2017 PU Award | $0 | 02/23/2017 | A | 29,452(7) | 02/23/2020 | 02/23/2020 | Common Stock | 29,452 | $0 | 29,452 | D |
Explanation of Responses: |
1. Shares reflect the vesting of the fourth tranche of market leveraged stock units granted in February 2013 at 200% of target based on our absolute total shareholder return during 2013-2016, plus dividend equivalents accrued during the period. |
2. Shares reflect the vesting of the third tranche of market leveraged stock units granted in February 2014 at 156% of target based on our absolute total shareholder return during 2014-2016, plus dividend equivalents accrued during the period. |
3. Shares reflect the vesting of the second tranche of market leveraged stock units granted in February 2015 at 153% of target based on our absolute total shareholder return in excess of 10% during 2015-2016, plus dividend equivalents accrued during the period. |
4. Shares reflect the vesting of the first tranche of market leveraged stock units granted in February 2016 at 123% of target based on our absolute total shareholder return in excess of 10% during 2016, plus dividend equivalents accrued during the period. |
5. Shares reflect the vesting of performance units granted in February 2014 at 200% of target, 50% based on our cumulative economic value added and 50% on our relative total shareholder return performance objectives established for the award. |
6. Market leveraged stock units vest 25% over one-, two-, three- and four-year performance periods using a conversion formula under which the number of shares earned at each vesting date is based on the Company's absolute total shareholder return, plus dividend equivalents accrued during the vesting period. Each marked leveraged stock unit represents a contingent right to receive one share of Avery Dennison Corporation common stock, plus dividend equivalents. |
7. Performance units vest, if at all, at the end of fiscal year 2019, provided certain Company performance objectives are met as determined in February 2020.? Each performance unit represents a contingent right to receive one share of Avery Dennison Corporation common stock. |
/s/ Erica Perry POA for Mitchell R Butier | 02/27/2017 | |
** 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. | ||
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. |