SEC Form 5
FORM 5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
Form 3 Holdings Reported.
Form 4 Transactions Reported.
UNITED STATES SECURITIES AND EXCHANGE COMMISSION | |||
OMB APPROVAL | |||
Washington, D.C. 20549 | |||
OMB Number: | 3235-0362 | ||
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL | Estimated average burden | ||
hours per response: | 1.0 | ||
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 |
1. Name and Address of Reporting Person *
PETERZALEK JOHN
(Last) | (First) | (Middle) |
2800 ROCKCREEK PARKWAY | ||
(Street) | ||
NORTH | MO | 64117 |
KANSAS CITY | ||
(City) | (State) | (Zip) |
2. | Issuer Name and Ticker or Trading Symbol | 5. Relationship of Reporting Person(s) to Issuer | ||
CERNER Corp[ CERN ] | (Check all applicable) | |||
Director | 10% Owner | |||
3. | Statement for Issuer's Fiscal Year Ended (Month/Day/Year) | |||
X | Officer (give title | Other (specify | ||
12/28/2019 | ||||
below) | below) | |||
EVP and Chief Client Officer | ||||
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 | 2A. Deemed | 3. | 4. Securities Acquired (A) or Disposed Of | 5. Amount of | 6. | 7. Nature of | ||
Date | Execution Date, | Transaction | (D) (Instr. 3, 4 and 5) | Securities | Ownership | Indirect | |||
(Month/Day/Year) | if any | Code (Instr. | Beneficially | Form: Direct | Beneficial | ||||
(Month/Day/Year) | 8) | (A) or | Owned at end of | (D) or | Ownership | ||||
Amount | Price | Issuer's Fiscal | Indirect (I) | (Instr. 4) | |||||
(D) | Year (Instr. 3 and | (Instr. 4) | |||||||
4) | |||||||||
Common Stock | 12/28/2019 | J(1) | 178 | A | $59.87(1)(2) | 8,731 | I | by 401(k) | |
Plan | |||||||||
by | |||||||||
Common Stock | 14,505 | I | Revocable | ||||||
Trust |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of | 2. | 3. Transaction | 3A. Deemed | 4. | 5. Number | 6. Date Exercisable and | 7. Title and Amount | 8. Price | 9. Number of | 10. | 11. Nature | |||
Derivative | Conversion | Date | Execution Date, | Transaction | of | Expiration Date | of Securities | of | derivative | Ownership | of Indirect | |||
Security | or Exercise | (Month/Day/Year) | if any | Code (Instr. | Derivative | (Month/Day/Year) | Underlying | Derivative | Securities | Form: | Beneficial | |||
(Instr. 3) | Price of | (Month/Day/Year) | 8) | Securities | Derivative Security | Security | Beneficially | Direct (D) | Ownership | |||||
Derivative | Acquired | (Instr. 3 and 4) | (Instr. 5) | Owned | or Indirect | (Instr. 4) | ||||||||
Security | (A) or | Following | (I) (Instr. 4) | |||||||||||
Disposed | Reported | |||||||||||||
of (D) | Transaction(s) | |||||||||||||
(Instr. 3, 4 | (Instr. 4) | |||||||||||||
and 5) | ||||||||||||||
Amount | ||||||||||||||
or | ||||||||||||||
Number | ||||||||||||||
Date | Expiration | of | ||||||||||||
(A) | (D) | Exercisable | Date | Title | Shares | |||||||||
Non- | ||||||||||||||
Qualified | ||||||||||||||
Stock | $67.24 | 05/12/2017 | 05/12/2025 | Common | 50,000 | 50,000 | D | |||||||
Option | Stock | |||||||||||||
(right to | ||||||||||||||
buy) | ||||||||||||||
Non- | ||||||||||||||
Qualified | ||||||||||||||
Stock | $55.24 | 05/10/2018 | 05/10/2026 | Common | 32,800 | 32,800 | D | |||||||
Option | Stock | |||||||||||||
(right to | ||||||||||||||
buy) | ||||||||||||||
Non- | ||||||||||||||
Qualified | ||||||||||||||
Stock | $65.27 | 05/01/2019 | 05/01/2027 | Common | 82,000 | 82,000 | D | |||||||
Option | Stock | |||||||||||||
(right to | ||||||||||||||
buy) | ||||||||||||||
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of | 2. | 3. Transaction | 3A. Deemed | 4. | 5. Number | 6. Date Exercisable and | 7. Title and Amount | 8. Price | 9. Number of | 10. | 11. Nature | |||
Derivative | Conversion | Date | Execution Date, | Transaction | of | Expiration Date | of Securities | of | derivative | Ownership | of Indirect | |||
Security | or Exercise | (Month/Day/Year) | if any | Code (Instr. | Derivative | (Month/Day/Year) | Underlying | Derivative | Securities | Form: | Beneficial | |||
(Instr. 3) | Price of | (Month/Day/Year) | 8) | Securities | Derivative Security | Security | Beneficially | Direct (D) | Ownership | |||||
Derivative | Acquired | (Instr. 3 and 4) | (Instr. 5) | Owned | or Indirect | (Instr. 4) | ||||||||
Security | (A) or | Following | (I) (Instr. 4) | |||||||||||
Disposed | Reported | |||||||||||||
of (D) | Transaction(s) | |||||||||||||
(Instr. 3, 4 | (Instr. 4) | |||||||||||||
and 5) | ||||||||||||||
Amount | ||||||||||||||
or | ||||||||||||||
Number | ||||||||||||||
Date | Expiration | of | ||||||||||||
(A) | (D) | Exercisable | Date | Title | Shares | |||||||||
Non- | ||||||||||||||
Qualified | ||||||||||||||
Stock | $57.24 | 05/04/2020 | 05/04/2028 | Common | 61,247 | 61,247 | D | |||||||
Option | Stock | |||||||||||||
(right to | ||||||||||||||
buy) | ||||||||||||||
Restricted | Common | |||||||||||||
Stock | $0.00 | 05/04/2021 | 05/04/2021 | 7,145 | 7,145 | D | ||||||||
Stock | ||||||||||||||
Units | ||||||||||||||
Restricted | Common | |||||||||||||
Stock | $0.00 | 09/07/2020 | 09/07/2021 | 31,139 | 31,139 | D | ||||||||
Stock | ||||||||||||||
Units | ||||||||||||||
Restricted | Common | |||||||||||||
Stock | $0.00 | 04/29/2020 | 04/29/2022 | 22,543 | 22,543 | D | ||||||||
Stock | ||||||||||||||
Units | ||||||||||||||
Explanation of Responses:
- Represents shares acquired through routine payroll deduction and participation in the issuer's 401(k) plan between 12/30/2018 and 12/28/2019, at prices ranging from $53.70 to $72.88 per share. Balance is based on plan statement as of 12/28/2019. This transaction qualifies as a non-discretionary transaction from a tax-qualified plan.
- Full information regarding the number of shares acquired at each separate price will be provided upon request by the Commission staff, Cerner Corporation, or a Cerner shareholder.
Remarks:
/s/ Shane M. Dawson, by Power 01/17/2020 of Attorney
** 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.
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Cerner Corporation published this content on 17 January 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 17 January 2020 21:18:04 UTC