FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL
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(Print or Type Responses)
1. Name and Address of Reporting Person *
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POLEWACZYK JAMES F |
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2. Date of Event Requiring Statement (Month/Day/Year) 01/15/2020 |
3. Issuer Name and Ticker or Trading Symbol IDEXX LABORATORIES INC /DE [IDXX]
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ONE IDEXX DRIVE |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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_____ 10% Owner
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__X__ Officer (give title below)
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_____ Other (specify below)
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Executive Vice President
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5. If Amendment, Date Original Filed
(Month/Day/Year)
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WESTBROOK, ME 04092 |
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4)
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2. Amount of Securities Beneficially Owned (Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)
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4. Nature of Indirect Beneficial Ownership (Instr. 5)
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Common Stock | 15,899 |
D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)
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2. Date Exercisable and Expiration Date (Month/Day/Year)
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3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5)
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6. Nature of Indirect Beneficial Ownership (Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Restricted Stock Unit |
(1) |
(1) | Common Stock | 2,281 (1) | (1) | D |
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Non-Qualified Stock Option (right-to-buy) |
(2) | 02/13/2024 | Common Stock | 1,126 (14) |
$62 (14) | D |
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Non-Qualified Stock Option (right-to-buy) |
(3) | 05/31/2014 | Common Stock | 4,028 (14) |
$62.24 (14) | D |
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Incentive Stock Option (right-to-buy) |
(4) | 02/13/2025 | Common Stock | 1,256 (14) |
$79.54 (14) | D |
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Non-Qualified Stock Option (right-to-buy) |
(5) | 02/13/2025 | Common Stock | 11,110 (14) |
$79.54 (14) | D |
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Non-Qualified Stock Option (right-to-buy) |
(6) | 02/13/2026 | Common Stock | 12,627 |
$67.85 | D |
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Incentive Stock Option (right-to-buy) |
(7) | 02/13/2025 | Common Stock | 1,476 |
$67.85 | D |
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Non-Qualified Stock Option (right-to-buy) |
(8) | 02/13/2027 | Common Stock | 7,151 |
$141.6 | D |
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Incentive Stock Option (right-to-buy) |
(9) | 02/13/2027 | Common Stock | 706 |
$141.6 | D |
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Non-Qualified Stock Option (right-to-buy) |
(10) | 02/13/2028 | Common Stock | 5,865 |
$178.26 | D |
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Incentive Stock Option (right-to-buy) |
(11) | 02/13/2028 | Common Stock | 560 |
$178.26 | D |
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Non-Qualified Stock Option (right-to-buy) |
(12) | 02/13/2029 | Common Stock | 5,711 |
$206.94 | D |
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Incentive Stock Option (right-to-buy) |
(13) | 02/13/2029 | Common Stock | 483 |
$206.94 | D |
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Reporting Owners
Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
POLEWACZYK JAMES F ONE IDEXX DRIVE WESTBROOK, ME 04092 |
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Executive Vice President |
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Signatures
/s/ Lily J. Lu, Attorney-in-Fact for James F. Polewaczyk | | 01/24/2020 |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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) | Each restricted stock unit represents a contingent right to receive one share of IDEXX Laboratories, Inc. common stock and vest in five equal annual installments beginning on the first anniversary of the date of grant. The number of restricted stock units reported was adjusted to reflect a 2-for-1 stock split in the form of a 100% stock dividend on IDEXX Laboratories, Inc. common stock paid on June 15, 2015 (the "Stock Split"). |
(2) | Grant of option to buy 6,039 shares of Issuer common stock that vest in five annual installments beginning on February 14, 2015, without giving effect to the Stock Split. |
(3) | Grant of option to buy 10,071 shares of Issuer common stock that vest in five annual installments beginning on June 1, 2015, without giving effect to the Stock Split. |
(4) | Grant of option to buy 628 shares of Issuer common stock that vests in one installment on February 14, 2020, without giving effect to the Stock Split. |
(5) | Grant of option to buy 5,555 shares of Issuer common stock that vest in five annual installments beginning on February 14, 2016, without giving effect to the Stock Split. |
(6) | Grant of option to buy 12,627 shares of Issuer common stock that vests in five annual installments beginning on February 14, 2017. |
(7) | Grant of option to buy 1,476 shares of Issuer common stock that vests as to 1 share on February 14, 2018, 1 share on February 14, 2019, and as to the remainder on February 14, 2021. |
(8) | Grant of option to buy 7,151 shares of Issuer common stock that vests in five annual installments beginning on February 14, 2018. |
(9) | Grant of option to buy 706 shares of Issuer common stock that vests in one installment on February 14, 2022. |
(10) | Grant of option to buy 5,865 shares of Issuer common stock that vests in five annual installments beginning on February 14, 2019. |
(11) | Grant of option to buy 560 shares of Issuer common stock that vests in one installment on February 14, 2023. |
(12) | Grant of option to buy 5,711 shares of Issuer common stock that vests in five annual installments beginning on February 14, 2020. |
(13) | Grant of option to buy 483 shares of Issuer common stock that vests in one installment on February 14, 2024. |
(14) | The number of derivative securities reported as beneficially owned and price with respect to this option were adjusted to reflect the Stock Split. |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.
Potential persons who are to 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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