Annual Statement of Changes in Beneficial Ownership (5)
February 14 2020 - 09:08AM
Edgar (US Regulatory)
FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response... 1.0 |
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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 * MONTGOMERY THOMAS
M |
2. Issuer Name and Ticker or Trading
SymbolAMETEK INC/ [AME] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
SR. VP. - COMPTROLLER |
(Last)
(First)
(Middle)
1100 CASSATT ROAD |
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2019
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(Street)
BERWYN, PA 19312
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
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1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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) |
Amount |
(A) or (D) |
Price |
Common Stock |
12/24/2019 |
|
G |
23 |
D |
$0 |
20545 |
D |
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401k Plan |
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3333 (1) |
I |
401k Plan |
Common Stock/ Serp |
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|
|
|
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1773 (2) |
D |
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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 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
(MM/DD/YYYY) |
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 at End of Issuer's Fiscal Year
(Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I)
(Instr. 4) |
11. Nature of Indirect Beneficial Ownership
(Instr. 4) |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of
Responses: |
(1) |
Reflects the reporting
person's interest in equivalent shares held by the AMETEK Common
Stock Fund (the "Fund") in The AMETEK Retirement and Savings Plan
(the "401(k) Plan"). The Fund consists of AMETEK common stock
(approximately 98% of the Fund's value) and cash or cash
equivalents (approximately 2% of the Fund's value). The number of
shares attributed to the reporting person as a Plan participant and
expressed as equivalent shares has been calculated based on the
closing price of AMETEK common stock in relation to the Net Asset
Value of the Fund on the date of the reported transaction and may
change from time to time without the volition of the reporting
person depending on the fair market value of AMETEK common stock
and the amount of cash in the Fund. |
(2) |
Pursuant to the Supplemental
Executive Retirement Plan ("SERP"), reflects the reporting person's
deemed investment in the AMETEK Common Stock Fund (the "Fund"), an
investment option within the AMETEK Retirement and Savings Plan.
The Fund consists of AMETEK common stock (approximately 98% of the
Fund's value) and cash or cash equivalents (approximately 2% of the
Fund's value). The number of shares attributed to the reporting
person as a Plan participant and expressed as equivalent shares has
been calculated based on the closing price of AMETEK common stock
in relation to the Net Asset Value of the Fund on the date of the
reported transaction and may change from time to time without the
volition of the reporting person depending on the fair market value
of AMETEK common stock and the amount of cash in the
Fund. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
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Director |
10% Owner |
Officer |
Other |
MONTGOMERY THOMAS M
1100 CASSATT ROAD
BERWYN, PA 19312 |
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|
SR. VP. - COMPTROLLER |
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Signatures
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/s/ Lynn Carino, attorney-in-fact for Mr.
Montgomery |
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2/14/2020 |
**Signature of Reporting
Person |
Date |