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Davis Daniel DonenFORM 4UNITED 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 1940OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response:
0.5OMB APPROVALOMB Number:
3235-0287
Estimated average burden
hours per response:
0.5OMB Number:3235-0287Estimated average burdenhours per response: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*Davis Daniel Donen
(Last)
(First)
(Middle)
ONE PENUMBRA PLACE
(Street)
ALAMEDA
CA
94502
(City)
(State)
(Zip)(Last)(First)(Middle)ONE PENUMBRA PLACEALAMEDACA(City)(State)(Zip)2. Issuer Name and Ticker or Trading Symbol
Penumbra Inc
[ PEN ]5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director
10% Owner
X
Officer (give title below)
Other (specify below)
See RemarksDirector10% OwnerXOfficer (give title below)Other (specify below)See Remarks3. Date of Earliest Transaction
(Month/Day/Year)
11/15/20184. 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 PersonForm filed by One Reporting PersonForm filed by More than One Reporting PersonTable I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned1. 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)CodeVAmount(A) or (D)PriceCommon Stock11/15/2018F(1)D62,338(2)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 Security3. 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)(A)(D)Date ExercisableExpiration DateTitleAmount or Number of SharesExplanation of Responses:1. These shares were withheld by or surrendered to Penumbra to pay the reporting person's tax withholding obligations incurred in connection with the vesting of the related restricted stock.2. A portion of these shares is subject to vesting.Remarks:The Reporting Person is Chief Commercial Officer and President, North America./s/ Johanna Roberts, as attorney-in-fact for Daniel Donen Davis11/19/2018** Signature of Reporting PersonDateReminder: 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.PK ! XJ docProps/app.xml
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