Initial Statement of Beneficial Ownership (3)
March 01 2018 - 3:48PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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GOEDKEN DENNIS W
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2. Date of Event Requiring Statement (MM/DD/YYYY)
3/1/2018
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3. Issuer Name
and
Ticker or Trading Symbol
PATTERSON COMPANIES, INC. [PDCO]
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(Last)
(First)
(Middle)
1031 MENDOTA HEIGHTS ROAD
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Interim CFO /
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(Street)
ST. PAUL, MN 55120
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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4285
(1)
(2)
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D
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Common Stock
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815
(3)
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I
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By ESOP
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(1)
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Includes 1,576 shares of restricted stock received through awards in the years 2013 through 2015 to Reporting Person, which vest, contingent upon continued employment, as follows: 297 shares vest 4/29/2018, 282 shares vest 7/1/2018, 238 shares vest 7/1/2018, 283 shares vest 7/1/2019, 238 shares vest 7/1/2019 and 238 shares vest 7/1/2020.
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(2)
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Includes 2,289 Restricted Stock Units ("RSUs") awarded on 7/1/2016 and 7/1/2017 to Reporting Person pursuant the Patterson Companies, Inc. 2015 Omnibus Incentive Plan. Each RSU represents a right, contingent upon continued employment, to receive one share of common stock. The 2016 RSUs vest as follows: 248 shares vest each year on the anniversary of the grant from 2018 through 2021. The 2017 RSUs vest as follows: 259 shares vest each year on the anniversary of the grant from 2018 through 2020 and 260 shares vest 7/1/2021 and 7/1/2022.
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(3)
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Represents shares of common stock indirectly held by the Reporting Person's Employee Stock Ownership Plan (ESOP) accounting through January 2, 2018.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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GOEDKEN DENNIS W
1031 MENDOTA HEIGHTS ROAD
ST. PAUL, MN 55120
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Interim CFO
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Signatures
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Les B. Korsh, by Power of Attorney
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3/1/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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