Statement of Changes in Beneficial Ownership (4)
June 08 2021 - 4:07PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
McShane Geri-Michelle |
2. Issuer Name and Ticker or Trading Symbol
Xylem Inc.
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XYL
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Accounting Officer |
(Last)
(First)
(Middle)
C/O XYLEM INC., 1 INTERNATIONAL DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/7/2021 |
(Street)
RYE BROOK, NY 10573
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 6/7/2021 | | M | | 1451 (1) | A | $74.07 | 3905 | D | |
Common Stock | 6/7/2021 | | S | | 1451 (1) | D | $119.33 (2) | 2454 | D | |
Common Stock | 6/7/2021 | | S | | 533 (1) | D | $119.33 (2) | 1921 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Stock Options (Right to Buy) | $74.07 | 6/7/2021 | | A | | 1451 | | (3) | 2/20/2029 | Common | 1451 | $0.00 | 747 | D | |
Explanation of Responses: |
(1) | The sale was made pursuant to a 10b5-1 plan adopted by the reporting person on May 7, 2021. |
(2) | This price represents the weighted average price per share of common stock (each, a "Share") of Xylem Inc. (the "Issuer"). The Reporting Person undertakes to provide, upon request by the Securities and Exchange Commission staff, the Issuer or a security holder of the Issuer, full information regarding the number of Shares sold at each price. |
(3) | Reflects an award of non-qualified stock options pursuant to the Xylem 2011 Omnibus Incentive Plan, that are scheduled to vest in one third increments on February 20, 2020, February 21, 2021 and February 20, 2022 |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
McShane Geri-Michelle C/O XYLEM INC. 1 INTERNATIONAL DRIVE RYE BROOK, NY 10573 |
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| Chief Accounting Officer |
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Signatures
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/s/ Kimberly Rehm, by power of attorney for Geri-Michelle McShane | | 6/8/2021 |
**Signature of Reporting Person | Date |
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