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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 | |
BAILLY R JEFFREY C/O UFP TECHNOLOGIES, INC. 172 EAST MAIN STREET GEORGETOWN, MA 01833 |
X | X | President and CEO |
Patrick J. Kinney, Jr., as attorney-in-fact for R. Jeffrey Bailly | 02/23/2010 | |
**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 restricted stock units granted on February 24, 2009, under the issuer's 2003 Incentive Plan subject to satisfaction of performance targets that are to be settled solely in shares of common stock. The transaction date represents the date on which the issuer's Compensation Committee determined the performance targets were achieved. The units vest with respect to one-third of the shares on February 24, 2011 and with respect to an additional one-third on each of February 24, 2012 and 2013, so long as the recipient is in the continuous employ of the Issuer through each such respective vesting date. |
(2) | Represents shares of common stock to be issued on December 31, 2010 under the issuer's 2003 Incentive Plan, so long as the recipient is in the continuous employ of the issuer through such issue date. |