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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Bevis Harold C C/O XERIUM TECHNOLOGIES, INC. 14101 CAPITAL BOULEVARD YOUNGSVILLE, NC 27596 |
X | President & CEO |
/s/ Kevin McDougall, by power of attorney | 01/30/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Reflects the corrected number of restricted stock units ("RSUs") subject to the awards granted to the Reporting Person as a result of the action of the Compensation Committee of the Board of Directors of the Issuer on January 29, 2015 to void 111,194 RSUs originally subject to the award. This amended Form 4 is also filed to correct the Transaction Date previously reported. |
(2) | Each RSU represents a contingent right to receive one share of the common stock of the Issuer upon vesting of the underlying RSU. 19,403 of the RSUs shall vest on March 15, 2016, subject to the Reporting Person's continued service to the Issuer through such date, and shall be subject to early acceleration and payment consistent with the terms of the Issuer's 2013-2015 Long Term Incentive Plan and LTIP Share Agreement thereunder. 130,597 of the RSUs are subject to performance-based vesting, and shall be subject to early acceleration and payment consistent with the terms of the Issuer's 2013-2015 Long Term Incentive Plan and LTIP Share Agreement thereunder. |