FORM 4
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN 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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(Print or Type Responses)
1. Name and Address of Reporting Person *
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Ball David Edward |
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2. Issuer Name and Ticker or Trading Symbol AVANOS MEDICAL, INC. [AVNS]
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5. 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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SVP - Global Supply Chain
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5405 WINDWARD PKWY |
3. Date of Earliest Transaction (Month/Day/Year) 09/06/2022 |
ALPHARETTA, GA 30004 |
4. If Amendment, Date Original Filed
(Month/Day/Year)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Transaction Date (Month/Day/Year)
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2A. Deemed Execution Date, if any (Month/Day/Year)
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3. Transaction Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 09/06/2022 |
| F |
| 2,015 (1) | D |
$23.87 | 11,968 (2) | D |
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Common Stock | 09/06/2022 |
| F |
| 733 (3) | D |
$23.87 | 11,235 | D |
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Common Stock | 09/06/2022 |
| F |
| 599 (4) | D |
$23.87 | 10,636 | D |
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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) |
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)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date (Month/Day/Year)
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3A. Deemed Execution Date, if any (Month/Day/Year)
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4. Transaction Code (Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5)
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6. Date Exercisable and Expiration Date (Month/Day/Year)
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7. Title and Amount of Underlying Securities (Instr. 3 and 4)
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8. Price of Derivative Security (Instr. 5)
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9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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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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Reporting Owners
Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Ball David Edward 5405 WINDWARD PKWY ALPHARETTA, GA 30004 |
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SVP - Global Supply Chain |
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Signatures
/s/ Mojirade James, as attorney-in-fact for David E. Ball | |
09/08/2022 |
**Signature of Reporting Person | Date |
Explanation of Responses:
* | 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) | Reflects shares surrendered to the Issuer to satisfy tax withholding obligations upon the accelerated vesting of certain time-based restricted stock units ("TRSUs") granted to the Reporting Person on May 7, 2020. Pursuant to the terms of the Retention Incentive Agreement dated as of May 20, 2022 by and between the Issuer and the Reporting Person (the "Retention Incentive Agreement"), certain of the TRSUs granted to the Reporting Person on May 7, 2020, March 17, 2021 and March 4, 2022 vested upon the termination of the Reporting Person's employment with the Issuer on September 6, 2022. |
(2) | Reflects the forfeiture of a total of 13,586 unvested TRSUs on September 6, 2022. Pursuant to the terms of the Retention Incentive Agreement, all the TRSUs granted on May 7, 2020, March 17, 2021 and March 4, 2022 that did not vest on September 6, 2022 as described in footnote 1 were forfeited. Such forfeited TRSUs were previously reported as beneficially owned in the Form 4s filed by the Reporting Person. |
(3) | Reflects shares surrendered to the Issuer to satisfy tax withholding obligations upon the accelerated vesting, pursuant to the terms of the Retention Incentive Agreement, of certain TRSUs granted to the Reporting Person on March 17, 2021, as described in footnote 1. |
(4) | Reflects shares surrendered to the Issuer to satisfy tax withholding obligations upon the accelerated vesting, pursuant to the terms of the Retention Incentive Agreement, of certain TRSUs granted to the Reporting Person on March 4, 2022, as described in footnote 1. |
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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