SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
BLOSS DAVID A SR

(Last) (First) (Middle)
C/O CIRCOR INTERNATIONAL, INC.
35 CORPORATE DRIVE, SUITE 290

(Street)
BURLINGTON MA 01803

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CIRCOR INTERNATIONAL INC [ CIR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chairman, President and CEO
3. Date of Earliest Transaction (Month/Day/Year)
08/11/2003
4. 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 I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/11/2003 M 17,310 A $6.3178(1) 52,071 D(2)
Common Stock 08/11/2003 F 5,799 D $18.45(3) 46,272 D(2)
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) 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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Restricted Stock Units $6.3178(1) 08/11/2003 M 17,310 08/11/2001 08/11/2003(4) Common Stock 17,310 $0(5) 0 D
Explanation of Responses:
1. Shares acquired pursuant to conversion of Restricted Stock Units (RSUs) 1 for 1. RSUs issued pursuant to issuer's Management Stock Purchase Plan under which executives may make advance elections to receive RSUs in lieu of a specified percentage or dollar amount of their annual incentive cash bonus under the bonus plan applicable to the executive. RSUs issued on the basis of a 33% discount to the fair market value of the issuer's Common Stock on the date the underlying bonus otherwise would be paid and generally vest 3 years after the date of grant, at which time they are converted into shares of issuer's Common Stock unless the executive has previously elected a longer deferral period. Transactions reported herein reflect conversion of RSUs into shares and withholding of sufficient shares to pay income taxes due. Price reflected above is based on 33% discount from fair market value of a share of issuer's Common Stock on 8/11/1998, the date of grant of the RSUs.
2. 500 of the total number of shares beneficially owned by the reporting person are held indirectly by the reporting person as they are held in his spouse's name.
3. Price reflects the fair market value of a share of the issuer's Common Stock on the date the shares are withheld by the issuer to pay taxes.
4. The date reported above is the date to which the reporting person previously had elected to defer conversion of the RSUs into shares of Common Stock.
5. The RSUs convert into shares of Common Stock on a 1 for 1 basis.
Alan J. Glass, Attorney in fact 08/12/2003
** 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 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).
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