------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response.........0.5 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 |_| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |_| Form 3 Holdings Reported |_| Form 4 Transactions Reported (Print of Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* O'Brien Francis J. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 951 Calle Amanecer - -------------------------------------------------------------------------------- (Street) San Clemente CA 92673 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol ICU Medical, Inc. (ICUI) ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) ________________________________________________________________________________ 4. Statement for Month/Day/Year November 4, 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) |X| Director |_| 10% Owner |X| Officer (give title below) |_| Other (specify below) Chief Financial Officer ----------------------- ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check Applicable line) |X| Form Filed by One Reporting Person |_| Form Filed by More than One Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. Amount of 6. 4. Securities Owner- Securities Acquired (A) or Beneficially ship 2A. 3. Disposed of (D) Owned Form: 7. 2. Deemed Transaction (Instr. 3, 4 and 5) Following Direct Nature of Trans- Execution Code ------------------------------- Reported (D) or Indirect 1. action Date, if (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Date any ------------ or (Instr. 3 & (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price Instr.4) (Instr.4) (Instr.4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 50 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 50 D 40.6000 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 950 A 7.917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 950 D 40.7700 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 300 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 300 D 40.8000 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 450 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 450 D 40.8600 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 4,900 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 4,900 D 41.0000 - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== 5. Amount of 6. 4. Securities Owner- Securities Acquired (A) or Beneficially ship 2A. 3. Disposed of (D) Owned Form: 7. 2. Deemed Transaction (Instr. 3, 4 and 5) Following Direct Nature of Trans- Execution Code ------------------------------- Reported (D) or Indirect 1. action Date, if (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Date any ------------ or (Instr. 3 & (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price Instr.4) (Instr.4) (Instr.4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 2,950 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 2,950 D 41.0200 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 2,200 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 2,200 D 41.0300 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 1,000 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 1,000 D 41.0400 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 2,100 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 2,100 D 41.0800 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 X 5,100 A 7.2917 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/4/02 S 5,100 D 41.12000 -0- D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3,750 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 600 I (1) - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================ Explanation of Responses: * Options not exercisable at December 31, 2001 may become exercisable before date indicated, upon achievement of certain performance goals as specified the option agreement. ** See * 16,945 options of the 94, 030 in Column 6 are exercisable. *** Options exercisable one-third annually over the first three anniversaries of the grant date. /s/ Francis J. O'Brien 11/5/02 - --------------------------------------------- ----------------------- **Signature of Reporting Person Date Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * 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). Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
9. Number 10. of Owner- deriv- ship ative Form 2. Secur- of Conver- 5. 7. ities Deriv- 11. sion Number of Title and Amount Bene- ative Nature or Derivative 6. of Underlying 8. ficially Secur- of Exer- 3A. 4. Securities Date Securities Price Owned ity: In- cise Deemed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Follow- Direct direct Price 3. Execut- action or Disposed Expiration Date ---------------- Deriv- ing (D) or Bene- 1. of Trans- ion Code of(D) (Month/Day/Year) Amount ative Reported In- ficial Title of Deriv- action Date if (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative Date any 8) 4 and 5) Date Expira- Number ity action(s) (I) ship Security Secur- (mm/dd/ (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity yy) yy) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Options to 7.2917 11/4/02 20,000 11/19/07** 11/19/08 Common 20,000 N/A 94,030 D Acquire Stock Common Stock - ------------------------------------------------------------------------------------------------------------------------------------ Options to 4.2917 11/25/01 01/02/10 Common N/A 1,500 D Acquire Stock Common Stock - ------------------------------------------------------------------------------------------------------------------------------------ Options to 1.5834 11/25/01 07/01/10 Common N/A 1,500 D Acquire Stock Common Stock - ------------------------------------------------------------------------------------------------------------------------------------ Options to 9.5834 11/25/01 01/04/11 Common N/A 1,027 D Acquire Stock Common Stock - ------------------------------------------------------------------------------------------------------------------------------------ Options to 29.1634 *** 11/11/12 Common N/A 1,500 D Acquire Stock Common Stock (Grant 11/1/01) - ------------------------------------------------------------------------------------------------------------------------------------ Options to 36.035 *** 09/20/13 Common N/A 12,500 D Acquire Stock Common Stock (Grant 9/20/02) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================