PK ! \Ȩ#
xl/worksheets/sheet1.xml
0
1234567890.5
4
567890.5
67
8
90.5
10
4
567890.5
67
8
90.5
67
8
90.5
PK ! kK K xl/worksheets/sheet2.xml
110121314151617945021819202122232425262728
0
121314
15
161794502
181920
2324
252627
28
29
3031253233
2532
33
0
121314
15
161794502
181920
2324
252627
28
2532
33
PK ! h xl/worksheets/sheet3.xml
34
3536373839404142
4344454647
4849504500513.981368195253
PK ! Fx! ! xl/worksheets/sheet4.xml
54
555657585960616263646566
4344676869707172
733.9874504500-47548450004550076
PK ! bs s xl/worksheets/sheet5.xml
77
78
79
80
81
82
PK ! 1N N xl/worksheets/sheet6.xml
8384
8586
87
88
89
90
91
PK ! j: : xl/workbook.xml
PK ! oE>)P P xl/sharedStrings.xml
Rothman LynnFORM 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*Rothman Lynn
(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)
EVP and Chief Business OfficerDirector10% OwnerXOfficer (give title below)Other (specify below)EVP and Chief Business Officer3. Date of Earliest Transaction
(Month/Day/Year)
11/30/20184. 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 Stock11/30/2018(1)MAI(2)By Trust(3)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 SharesStock Option (right to buy)11/30/201806/12/2021DExplanation of Responses:1. This transaction is being reported late due to administrative oversight.2. The Reporting Person previously held shares directly. Changes between direct holdings and indirect holdings through a family revocable trust are in transactions exempt from Section 16 pursuant to Rule 16a-13 under the Securities Exchange Act of 1934 as mere changes in form of beneficial ownership.3. Trust of Richard E. Koch and Lynn D. Rothman4. All options are vested and exercisable.Remarks:/s/ Johanna Roberts, as attorney-in-fact for Lynn Rothman04/15/2019** 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 ! *F docProps/app.xml
Microsoft Excel0falseWorksheets6rothman lynnrothman lynn-1rothman lynn-2rothman lynn-3rothman lynn-4rothman lynn-5falsefalsefalse12.0000PK ! ֥P P docProps/core.xml
2020-01-09T18:33:10Z2020-01-09T18:33:10ZPK ! t7 7 [Content_Types].xml
PK ! )H
xl/styles.xml
PK ! FTR R xl/theme/theme1.xml
PK ! IK K _rels/.rels
PK ! xz z xl/_rels/workbook.xml.rels
PK ! \Ȩ#
xl/worksheets/sheet1.xmlPK ! kK K 8
xl/worksheets/sheet2.xmlPK ! h xl/worksheets/sheet3.xmlPK ! Fx! ! ' xl/worksheets/sheet4.xmlPK ! bs s D4 xl/worksheets/sheet5.xmlPK ! 1N N 7 xl/worksheets/sheet6.xmlPK ! j: : q= xl/workbook.xmlPK ! oE>)P P @ xl/sharedStrings.xmlPK ! *F ZY docProps/app.xmlPK ! ֥P P M] docProps/core.xmlPK ! t7 7 _ [Content_Types].xmlPK ! )H
4g xl/styles.xmlPK ! FTR R 8p xl/theme/theme1.xmlPK ! IK K _rels/.relsPK ! xz z / xl/_rels/workbook.xml.relsPK