SEC FORM
4/A
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
|
OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
|
|
|
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*
C/O CONMED CORPORATION |
525 FRENCH ROAD |
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
CONMED CORP
[ CNMD ]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
|
10% Owner |
|
Officer (give title below) |
|
Other (specify below) |
|
|
3. Date of Earliest Transaction
(Month/Day/Year) 07/30/2013
|
4. If Amendment, Date of Original Filed
(Month/Day/Year) 07/30/2013
|
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 |
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 |
Rsus (restricted Stock Units) |
$0
|
|
|
|
|
|
|
06/01/2014
|
07/26/2023 |
Common Stock |
3,000 |
|
3,000 |
D |
|
Sars (Stock Appreciation Rights) |
$33.43
|
|
|
|
|
|
|
06/01/2014
|
07/26/2023 |
Common Stock |
1,000 |
|
1,000 |
D |
|
Explanation of Responses: |
Remarks: |
|
Daniel S. Jonas for Dirk Kuyper by Power of Attorney |
08/02/2013 |
|
** 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. |
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 Number. |
DURABLE GENERAL POWER OF ATTORNEY
NEW YORK STATUTORY SHORT FORM
THE POWERS YOU GRANT BELOW CONTINUE TO BE EFFECTIVE
SHOULD YOU BECOME DISABLED OR INCOMPETENT
CAUTION: THIS IS AN IMPORTANT DOCUMENT. IT GIVES THE PERSON WHOM
YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY
DURING YOUR LIFETIME, WHICH MAY INCLUDE POWERS TO MORTGAGE, SELL,
OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT
ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THESE POWERS WILL CONTINUE
TO EXIST EVEN AFTER YOU BECOME DISABLED OR INCOMPETENT. THESE POWERS
ARE EXPLAINED MORE FULLY IN NEW YORK GENERAL OBLIGATIONS LAW,
ARTICLE 5, TITLE 15, SECTIONS 5-1502A THROUGH 5-1503, WHICH
EXPRESSLY PERMIT THE USE OF ANY OTHER OR DIFFERENT FORM OF POWER OF
ATTORNEY.
THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER
HEALTH CARE DECISIONS. YOU MAY EXECUTE A HEALTH CARE PROXY TO DO THIS.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND,
YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.
THIS is intended to constitute a DURABLE GENERAL POWER OF ATTORNEY
pursuant to Article 5, Title 15 of the New York General Obligations Law:
I, Dirk Kuyper, residing at 131 Hope Street, Bristol,
Rhode Island 02809 do hereby appoint:
Daniel S. Jonas, Esq., Executive Vice President - Legal Affairs and
General Counsel
Robert D. Shallish, Jr., Executive Vice President ? Finance and
Chief Financial Officer
Heather L. Cohen, Esq., Executive Vice President Corporate HR and
Deputy General Counsel
Simone Shaheen, Esq., Assistant General Counsel
(If 1 person is to be appointed agent, insert the name
and address of your agent above)
(If 2 or more persons are to be appointed agents by you insert their names
and addresses above)
my attorney(s)-in-fact TO ACT
(If more than one agent is designated, CHOOSE ONE of the following two choices
by putting your initials in ONE of the blank spaces to the left of your choice:)
[Intl. ] Each agent may SEPARATELY act.
[ ] All agents must act TOGETHER.
(If neither blank space is initialed, the agents will be required to
act TOGETHER)
IN MY NAME, PLACE AND STEAD in any way which I myself could do, if I were
personally present, with respect to the following matters as each of them is
defined in Title 15 of Article 5 of the New York General Obligations Law
to the extent that I am permitted by law to act through an agent:
[ Intl.] Execution of Documents relating to Exercise of Options
and/or Sale of Conmed Common Stock, including but not limited to any
SEC Form 4, SEC Form 5, SEC Form 144, or any lock up agreement.
(Special provisions and limitations may be included in the statutory short
form durable power of attorney only if they conform to the requirements of
section 5-1503 of the New York General Obligations Law.)
This Durable Power of Attorney shall not be affected by my subsequent
disability or incompetence.
If every agent named above is unable or unwilling to serve,
I appoint (insert name and address of successor)
N/A to be my agent for all purposes hereunder.
TO INDUCE ANY THIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT ANY
THIRD PARTY RECEIVING A DULY EXECUTED COPY OR FACSIMILE OF THIS INSTRUMENT
MAY ACT HEREUNDER, AND THAT REVOCATION OR TERMINATION HEREOF SHALL BE
INEFFECTIVE AS TO SUCH THIRD PARTY UNLESS AND UNTIL ACTUAL NOTICE OR
KNOWLEDGE OF SUCH REVOCATION OR TERMINATION SHALL HAVE BEEN RECEIVED
BY SUCH THIRD PARTY, AND I FOR MYSELF AND FOR MY HEIRS, EXECUTORS,
LEGAL REPRESENTATIVES AND ASSIGNS, HEREBY AGREE TO INDEMNIFY AND
HOLD HARMLESS ANY SUCH THIRD PARTY FROM AND AGAINST ANY AND ALL CLAIMS
THAT MAY ARISE AGAINST SUCH THIRD PARTY BY REASON OF SUCH THIRD PARTY
HAVING RELIED ON THE PROVISIONS OF THIS INSTRUMENT.
THIS DURABLE GENERAL POWER OF ATTORNEY MAY BE REVOKED BY ME AT ANY TIME.
IN WITNESS WHEROF, I have hereunto signed my name this day 30 of July, 2013.
(YOU SIGN HERE:) ==> /s/Dirk Kuyper
Dirk Kuyper