Statement of Changes in Beneficial Ownership (4)
September 02 2021 - 4:34PM
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
*
Pine Matthew Francis |
2. Issuer Name and Ticker or Trading Symbol
Xylem Inc.
[
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) Senior Vice President |
(Last)
(First)
(Middle)
1 INTERNATIONAL DRIVE, C/O XYLEM INC. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/1/2021 |
(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 | 9/1/2021 | | M | | 2000 | A | $63.55 | 39217 | D | |
Common Stock | 9/1/2021 | | S | | 2000 (1) | D | $136.3626 (2) | 37217 | 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 Option (Right to Buy) | $63.55 | 9/1/2021 | | M | | | 2000 | (3) | 5/7/2030 | Common | 2000 | $0.00 | 46423 | D | |
Explanation of Responses: |
(1) | The sale was made pursuant to a 10b5-1 plan adopted by the reporting person on March 15, 2021. |
(2) | This price represents the weighted average price per share of common stock (each, a "Share") of Xylem Inc. (the "Issuer"). 794 Shares were executed at a range of prices from $135.44 to $136.43. 1,204 Shares were executed at a range of prices from $136.44 to $136.84. 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) | The May 7, 2020 option grant vests in one third increments on May 7, 2021, May 7, 2022 and May 7, 2023. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Pine Matthew Francis 1 INTERNATIONAL DRIVE C/O XYLEM INC. RYE BROOK, NY 10573 |
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| Senior Vice President |
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Signatures
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/s/ Kimberly Rehm, by power of attorney for Matthew F. Pine | | 9/2/2021 |
**Signature of Reporting Person | Date |
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