Statement of Changes in Beneficial Ownership (4)
April 09 2015 - 10:17AM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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
*
Moore Daniel Jeffrey
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2. Issuer Name
and
Ticker or Trading Symbol
CYBERONICS INC
[
CYBX
]
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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)
President & CEO
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(Last)
(First)
(Middle)
100 CYBERONICS BLVD
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3. Date of Earliest Transaction
(MM/DD/YYYY)
3/15/2015
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(Street)
HOUSTON, TX 77058
(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
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3/15/2015
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F
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5770
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D
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(1)
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121324
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D
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Common Stock
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0
(2)
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I
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Moore Family 2011 Gift Trust
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Common Stock
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0
(3)
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I
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Moore Family 2012 Gift Trust
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Common Stock
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2586
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I
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DJM Family Partnership Ltd.
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Common Stock
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14560
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I
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Grace M. Moore
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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. 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
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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 Following Reported Transaction(s) (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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Code
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V
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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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Phantom Stock Unit
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$65.26
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3/15/2015
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M
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5888
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(4)
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9/15/2021
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Phantom Stock Unit
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5888
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$0.00
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194760
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D
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Explanation of Responses:
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(
1)
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The referenced shares were withheld from distribution at the request of Reporting Person. Such shares were forfeited and the associated value was used to offset the tax liability associated with the March 15, 2015 vesting of 19,113 shares of restricted stock.
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(
2)
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Beneficiaries of the Moore Family 2011 Gift Trust are Reporting Person's adult children, one of whom resided with Reporting Person until February 2015. Reporting Person no longer has a pecuniary interest in this trust.
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(
3)
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Beneficiaries of the Moore Family 2012 Gift Trust are Reporting Person's adult children, one of whom resided with Reporting Person until February 2015. Reporting Person no longer has a pecuniary interest in this trust.
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(
4)
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Reporting Person was granted an award of 23,551 Phantom Stock Units that vest as set forth in the Phantom Stock Agreement dated September 15, 2011. Subject to the Phantom Stock Agreement, the Phantom Stock Units may be settled in cash or shares of Cyberonics, Inc. common stock as determined by the Plan Administrator.
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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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Moore Daniel Jeffrey
100 CYBERONICS BLVD
HOUSTON, TX 77058
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X
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President & CEO
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Signatures
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Daniel J. Moore
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4/9/2015
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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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