Annual Statement of Changes in Beneficial Ownership (5)
14 January 2017 - 6:54AM
Edgar (US Regulatory)
FORM 5
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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).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
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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
*
LINEBARGER NORMAN THOMAS
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2. Issuer Name
and
Ticker or Trading Symbol
CUMMINS INC [CMI]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Chairman & CEO
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(Last)
(First)
(Middle)
500 JACKSON STREET
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2016
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(Street)
COLUMBUS, IN 47201
(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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Amount
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(A) or (D)
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Price
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Common
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8/30/2016
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G
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25900.0000
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A
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$0.0000
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40750.0000
(1)
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D
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Common
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8/30/2016
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G
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25900.0000
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D
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$0.0000
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240.0000
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I
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By Spouse
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Common
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7307.2100
(2)
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I
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By 401(k) Plan
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Common
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6457.0000
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I
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By Child #1
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Common
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6457.0000
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I
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By Child #2
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Common
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22430.0000
(3)
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I
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GRAT #1
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Common
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42386.0000
(4)
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I
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GRAT #2
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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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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Stock Option (Right-to-Buy)
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$19.4200
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3/2/2011
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3/2/2019
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Common
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24830.0000
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24830.0000
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D
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Stock Option (Right-to-Buy)
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$58.1150
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3/1/2012
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3/1/2020
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Common
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16360.0000
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16360.0000
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D
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Stock Option (Right-to-Buy)
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$109.0900
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4/4/2019
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4/4/2026
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Common
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131920.0000
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131920.0000
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D
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Stock Option (Right-to-Buy)
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$111.8400
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4/2/2015
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4/2/2023
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Common
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60100.0000
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60100.0000
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D
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Stock Option (Right-to-Buy)
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$119.7700
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5/2/2013
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5/2/2021
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Common
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13040.0000
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13040.0000
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D
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Stock Option (Right-to-Buy)
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$120.2800
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4/2/2014
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4/2/2022
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Common
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37510.0000
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37510.0000
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D
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Stock Option (Right-to-Buy)
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$136.8200
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4/2/2018
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4/2/2025
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Common
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60780.0000
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60780.0000
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D
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Stock Option (Right-to-Buy)
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$149.3400
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4/2/2017
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4/2/2024
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Common
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44890.0000
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44890.0000
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D
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Explanation of Responses:
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(
1)
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Shares are held in The Norman Thomas Linebarger Revocable Trust. Reflects an increase for 16,750 shares previously held by the Grantor Retained Annuity Trust #1 that were distributed to the reporting person and a decrease for 42,386 shares previously held directly by the reporting person that have been transferred to the Grantor Retained Annuity Trust #2.
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(
2)
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The number of shares is based on the dollar value of the reporting person's interest in the Cummins Stock Fund under the Company's 401(k) plan as most recently provided by the plan. The actual number of shares underlying the interest is not known since the Cummins Stock Fund is a unitized account consisting of approximately 98% common stock and 2% cash or cash equivalents.
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(
3)
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Reflects a decrease for 16,750 shares that were distributed to the reporting person.
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(
4)
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42,386 shares held by the reporting person have been transferred to the Grantor Retained Annuity Trust #2.
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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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LINEBARGER NORMAN THOMAS
500 JACKSON STREET
COLUMBUS, IN 47201
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X
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Chairman & CEO
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Signatures
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/s/ Mark Sifferlen, Attorney-In-Fact
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1/13/2017
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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 4(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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