SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
LOPEZ GEORGE A

(Last) (First) (Middle)

(Street)

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ICU MEDICAL INC/DE [ ICUI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chairman, President, CEO
3. Date of Earliest Transaction (Month/Day/Year)
06/09/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock owned by George A. Lopez, M.D. 2nd Family LP 08/08/1988(1) A 1,186,843 A 0 1,186,843(2) I (a)(3)
Common Stock owned by Lopez Family Trust 08/08/1988(1) A 23,223 A 0 23,223 I (a)(4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Options to Acquire Common Stock 5.54 08/08/1988(1) A 300,000 01/30/1999 01/31/2008 Common Stock 300,000 $0 300,000 D
Options to Acquire Common Stock 10.25 08/08/1988(1) A 352,763 01/30/1999 06/27/2007 Common Stock 352,763 $0 352,763 D
Options to Acquire Common Stock 8.17 08/08/1988(1) A 101,017 12/31/2001 01/02/2009 Common Stock 101,017 $0 101,017 D
Options to Acquire Common Stock 8.17 08/08/1988(1) A 48,982 01/30/1999 01/02/2009 Common Stock 48,982 $0 48,982 D
Options to Acquire Common Stock 8.17 08/08/1988(1) A 975,000 11/25/2001 01/02/2009 Common Stock 975,000 $0 975,000 D
Options to Acquire Common Stock 10.67 08/08/1988(1) A 16,512 12/31/2001 12/20/2010 Common Stock 16,512 $0 16,512 D
Options to Acquire Common Stock 10.33 08/08/1988(1) A 133,488 12/31/2001 12/20/2010 Common Stock 133,488 $0 133,488 D
Options to Acquire Common Stock (Granted 9/9/00) 14.63 08/08/1988(1) A 300,000 08/08/1988(5) 09/09/2011 Common Stock 300,000 $0 300,000 D
Options to Acquire Common Stock (Granted 12/9/00) 18.63 08/08/1988(1) A 75,000 08/08/1988(5) 12/09/2011 Common Stock 75,000 $0 75,000 D
Options to Acquire Common Stock (Granted 3/9/01) 19.46 08/08/1988(1) A 75,000 08/08/1988(5) 03/09/2012 Common Stock 75,000 $0 75,000 D
Options to Acquire Common Stock (Granted 6/8/01) 25.62 08/08/1988(1) A 75,000 08/08/1988(5) 06/08/2012 Common Stock 75,000 $0 75,000 D
Options to Acquire Common Stock (Granted 9/9/01) 23.77 08/08/1988(1) A 75,000 08/08/1988(5) 09/09/2012 Common Stock 75,000 $0 75,000 D
Options to Acquire Common Stock (Granted 12/9/01) 28.62 08/08/1988(1) A 75,000 08/08/1988(5) 12/09/2012 Common Stock 75,000 $0 75,000 D
Options to Acquire Common Stock (Granted 3/8/02) 33.55 08/08/1988(1) A 75,000 08/08/1988(5) 03/08/2013 Common Stock 75,000 $0 75,000 D
Options to Acquire Common Stock (Granted 6/9/02) 30.18 08/08/1988(1) A 75,000 08/08/1988(5) 06/09/2013 Common Stock 75,000 $0 75,000 D
Options to Acquire Common Stock (Granted 9/9/02) 36.03 08/08/1988(1) A 50,000 08/08/1988(5) 09/09/2013 Common Stock 50,000 $0 50,000 D
Options to Acquire Common Stock (Granted (12/9/02) 36.87 08/08/1988(1) A 50,000 08/08/1988(5) 12/09/2013 Common Stock 50,000 $0 50,000 D
Options to Acquire Common Stock (Granted 3/9/03) 26.15 08/08/1988(1) A 50,000 08/08/1988(5) 03/09/2014 Common Stock 50,000 $0 50,000 D
Options to Acquire Common Stock (Granted 6/9/03) 32.68 06/09/2003 A 50,000 08/08/1988(5) 06/09/2014 Common Stock 50,000 $0 50,000 D
Explanation of Responses:
1. Not a new transaction. Filed for the sole purpose of supplying the date as provided by the SEC. In fact, no date applies.
2. Excludes 22,959 shares held by Diana K. Lopez, M.D. Dr. Lopez disclaims any beneficial interest in the shares held by his wife.
3. Dr. Lopez holds a one percent general partnership interest in the Partnership. As general partner, he has power to vote and power to dispose of the 1,186,843 shares owned by the Partnership and may be deemed to be beneficial owner of such shares. The Partnership acquired the shares on 2/24/99 from Trusts for the benefit of the Lopez' children, the Christopher George Lopez Children's Trust and the Nicholas George Lopez Children's Trust, which own a 99% limited partnership interest in the Partnership. The Drs. Lopez are not trustees of and have no interest in their children's Trusts. Except to the extent of their undivided one percent general partnership interest in the assets of the Partnership, the Drs. Lopez disclaim any beneficial ownership of the shares owned by the Partnership.
4. Drs. Lopez are trustees and beneficiaries of the Family Trust. Except to the extent of their pecuniary interests as beneficiaries of the Family Trust, Drs. Lopez disclaim any beneficial ownership of the shares owned by the Family Trust.
5. Options exercisable one-third annually over the first three anniversaries of the grant date.
George A. Lopez, M.D. 06/09/2003
** Signature of Reporting Person Date
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* 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).
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