UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Non Qualified Stock Option (Right to Buy) | 11/09/2015(1) | 11/09/2019 | Common Stock | 4,057 | $ 60.91 | D | Â |
Non Qualified Stock Option (Right to Buy) | 02/21/2017(2) | 02/21/2021 | Common Stock | 4,343 | $ 74.06 | D | Â |
Non Qualified Stock Option (Right to Buy) | Â (3) | 02/13/2022 | Common Stock | 4,473 | $ 81.97 | D | Â |
Non Qualified Stock Option (Right to Buy) | Â (4) | 02/12/2023 | Common Stock | 6,064 | $ 67.12 | D | Â |
Restricted Stock Units | Â (5) | Â (5) | Common Stock | 631 | $ (6) | D | Â |
Restricted Stock Units | Â (7) | Â (7) | Common Stock | 1,194 | $ (6) | D | Â |
Restricted Stock Units | Â (8) | Â (8) | Common Stock | 2,185 | $ (6) | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MOMSEN MAGNUS C/O VARIAN MEDICAL SYSTEMS, INC. 3100 HANSEN WAY, MS E327 PALO ALTO, CA 94304 |
 |  |  SVP, CAO, Corporate Controller |  |
/s/ Franco N. Palomba, Attorney in Fact for Magnus Momsen | 02/06/2017 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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) | Stock option granted under the Varian Medical Systems, Inc. Third Amended and Restated 2005 Omnibus Stock Plan, which complies with Rule 16b-3. The option vests as follows: one third on 11/09/2013, and the remaining shares in 24 equal installments over the 24 months following the first vesting date. |
(2) | Stock option granted under the Varian Medical Systems, Inc. Third Amended and Restated 2005 Omnibus Stock Plan, which complies with Rule 16b-3. The option vests as follows: one third on 02/21/2015, and the remaining shares in 24 equal installments over the 24 months following the first vesting date. |
(3) | Stock option granted under the Varian Medical Systems, Inc. Third Amended and Restated 2005 Omnibus Stock Plan, which complies with Rule 16b-3. The option vests as follows: one third on 2/13/2016, and the remaining shares in 24 equal installments over the 24 months following the first vesting date. |
(4) | Stock option granted under the Varian Medical Systems, Inc. Third Amended and Restated 2005 Omnibus Stock Plan which complies with Rule 16b-3. The option vests as follows: one third on 2/12/2017, and the remaining shares in 24 equal installments over the 24 months following the first vesting date. |
(5) | The restricted stock units vest on February 15, 2017. Vested shares will be delivered to the reporting person on vest date. |
(6) | Each restricted stock unit represents a contingent right to receive one share of VAR common stock. |
(7) | The restricted stock units vest in three equal installments on February 15, 2016, February 15, 2017, and February 15, 2018. Vested shares will be delivered to the reporting person on vest date. |
(8) | The restricted stock units vest in three equal installments on February 15, 2017, February 15, 2018, and February 15, 2019. Vested shares will be delivered to the reporting person on vest date. |
 Remarks: The terms of each of the reporting person's outstanding options and restricted stock units were adjusted pursuant to the Employee Matters Agreement between Varian Medical Systems, Inc. ("Varian") and Varex Imaging Corporation ("Varex") relating to the January 28, 2017 distribution by Varian to its stockholders of all of the outstanding shares of the common stock of Varex.  All information regarding such options and restricted stock units is shown on this Form 3 on a post-adjustment basis. |