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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 | |
PIETRAFITTA CLIFFORD E C/O XERIUM TECHNOLOGIES INC 14101 CAPITAL BOULEVARD YOUNGSVILLE, NC 27596 |
CFO |
/s/ Kevin McDougall, by power of attorney | 03/04/2015 | |
**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) | Represents a new grant of 14,089 stock units ("Stock Units"), comprised of 4,931 time-based restricted stock units ("RSUs") and 9,158 performance-based stock units ("PSUs"). Each Stock Unit represents a contingent right to receive one share of common stock of the Issuer upon vesting of the underlying Stock Unit. The RSUs shall vest on March 2, 2018 and the PSUs shall vest, if at all, upon the attainment of certain performance criteria established by the Board of Directors of the Issuer. Subject to early acceleration and payment under certain circumstances consistent with the terms of the Issuer's 2015-2017 Long Term Incentive Plan and LTIP Share Agreement thereunder, delivery of the common stock underlying the Stock Units is subject to the Reporting Person's continued service to the Issuer through March 2, 2018. |
(2) | This amount represents shares of common stock held by the Reporting Person and shares of common stock underlying Stock Units granted to the Reporting Person. |