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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HOOPIS MICHAEL P 23 CORPORATE PLAZA SUITE 246 NEWPORT BEACH, CA 92660 |
X | President and CEO |
/s/ Michael P. Hoopis, by Richard D. Tipton pursuant to Power of Attorney previously filed with the SEC | 11/30/2004 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Non-market transaction. |
(2) | Pursuant to the terms of the Water Pik Technologies Inc. 1999 Incentive Plan, the Reporting Person irrevocably elected to defer receipt of 54,054 shares of restricted stock previously granted to him and receive a credit under his stock unit account of an equivalent number of stock units. As a result, the shares of restricted stock have been transferred to the Company and cancelled. The stock units credited to the Reporting Person's stock unit account shall be vested in accordance with the same terms and conditions contained in the applicable restricted stock award agreement. Vested stock units in the Reporting Person's stock unit account shall only be distributed in the form of common stock upon the occurrence of certain events as specified in the 1999 Incentive Plan. |
(3) | There is no price related to this transaction. See footnote 2 for details. |