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 | ||||
Phantom Stock Unit (1) | Â (1) | Â (1) | Common Stock | 18,222 | $ 0 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Kennedy Phillip B. C/O XERIUM TECHNOLOGIES, INC. 14101 CAPITAL BOULEVARD YOUNGSVILLE, NC 27596 |
 |  |  EVP, GC & Secretary |  |
/s/ Phillip Kennedy | 01/31/2018 | |
**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) | These Phantom Stock Units were awarded on 5/30/17 in connection with the reporting person's participation in the 2017-2019 Long-Term Incentive Plan of Xerium Technologies, Inc. Each Phantom Stock Unit is the economic equivalent of one share of Xerium Technologies, Inc. common stock. Subject to time and performance conditions and early vesting in limited circumstances, on 5/30/2020, the Phantom Stock Units will be settled in cash equal to the average closing price of the common stock for the 30-days preceding 5/30/2020. No shares of common stock will be issued in connection with the settlement of the Phantom Stock Units. |