1. Name and Address of Reporting Person*
| 9600 54TH AVENUE NORTH, SUITE 100 | |
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 10/05/2009 | 3. Issuer Name and Ticker or Trading Symbol ev3 Inc.
[evvv]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable) | Director | | 10% Owner | | X | Officer (give title below) | | Other (specify below) | | Sr. Vice President |
| 5. If Amendment, Date of Original Filed (Month/Day/Year)
|
6. Individual or Joint/Group Filing (Check Applicable Line)
| X | Form filed by One Reporting Person | | Form filed by More than One Reporting Person |
|
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |
|---|
| 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 Excercise Price of Derivative Security
| 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)
| 6. Nature of Indirect Beneficial Ownership (Instr. 5)
|
|---|
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
|---|
|
Stock Option (right to buy)
| | 09/14/2010 |
Common Stock
|
23,813
|
$
15.74
|
D
| |
|
Stock Option (right to buy)
| | 07/02/2011 |
Common Stock
|
14,288
|
$
12.7
|
D
| |
|
Stock Option (right to buy)
| | 01/09/2015 |
Common Stock
|
16,974
|
$
8.0623
|
D
| |
|
Stock Option (right to buy)
| | 02/28/2014 |
Common Stock
|
3,810
|
$
8.1463
|
D
| |
|
Stock Option (right to buy)
| | 04/03/2011 |
Common Stock
|
9,525
|
$
10.3
|
D
| |
|
Stock Option (right to buy)
| | 01/21/2017 |
Common Stock
|
11,250
|
$
17.67
|
D
| |
|
Stock Option (right to buy)
| | 10/03/2017 |
Common Stock
|
10,000
|
$
16.64
|
D
| |
|
Stock Option (right to buy)
| | 08/31/2018 |
Common Stock
|
11,075
|
$
12.21
|
D
| |
|
Stock Option (right to buy)
| | 05/01/2011 |
Common Stock
|
1,071
|
$
9.35
|
D
| |
|
Stock Option (right to buy)
| | 12/05/2015 |
Common Stock
|
18,000
|
$
13.54
|
D
| |
|
Stock Option (right to buy)
| | 02/11/2019 |
Common Stock
|
17,825
|
$
6.2
|
D
| |
| /s/ Kevin M. Klemz, attorney-in-fact | 10/07/2009 |
| ** Signature of Reporting Person | Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * 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).
|
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see Instruction 6 for procedure. |
| 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 Number. |