Initial Statement of Beneficial Ownership (3)
04 October 2016 - 7:06AM
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
Estimated average burden
hours per response...
0.5
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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
*
Singh Prahlad R.
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2. Date of Event Requiring Statement (MM/DD/YYYY)
10/3/2016
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3. Issuer Name
and
Ticker or Trading Symbol
PERKINELMER INC [PKI]
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(Last)
(First)
(Middle)
940 WINTER STREET
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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)
Please See Remarks /
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(Street)
WALTHAM, MA 02451
(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)
_
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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12461
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D
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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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NQ Stock Option (Right to Buy)
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(1)
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5/15/2021
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Common Stock
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9865
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$43.10
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D
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NQ Stock Option (Right to Buy)
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(2)
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2/3/2022
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Common Stock
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10636
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$46.26
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D
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NQ Stock Option (Right to Buy)
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(3)
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3/4/2023
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Common Stock
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14187
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$48.98
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D
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Explanation of Responses:
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(
1)
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This option vested as to 1/3 of the underlying shares on May 15, 2015, which was the first anniversary of the date of grant, with an additional 1/3 of the underlying shares vesting on May 15, 2016, which was the second anniversary of the date of grant. The remaining 1/3 of the underlying shares will vest on May 15, 2017, which is the third anniversary of the date of grant.
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(
2)
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This option vested as to 1/3 of the underlying shares on February 3, 2016, which was the first anniversary of the date of grant, and is scheduled to vest in equal installments thereafter until the third anniversary of the date of grant.
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(
3)
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This option is scheduled to vest in three equal annual installments beginning on March 4, 2017 which is the first anniversary of the date of grant.
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Remarks:
Senior Vice President and President, Diagnostics
Exhibit List:
Exhibit 24 - Power of Attorney
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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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Singh Prahlad R.
940 WINTER STREET
WALTHAM, MA 02451
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Please See Remarks
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Signatures
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/s/ John L. Healy (POA on file) for Prahlad R. Singh
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10/3/2016
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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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