| FORM
3 |
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
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person
*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year)
10/03/2016
|
3. Issuer Name
and
Ticker or Trading Symbol
PERKINELMER INC
[
PKI
]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Please See Remarks |
|
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 I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
|
3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
4. Nature of Indirect Beneficial Ownership (Instr.
5)
|
|
Common Stock
|
12,461
|
D
|
|
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 Exercise 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 |
|
NQ Stock Option (Right to Buy)
|
|
05/15/2021 |
Common Stock
|
9,865
|
43.1
|
D
|
|
|
NQ Stock Option (Right to Buy)
|
|
02/03/2022 |
Common Stock
|
10,636
|
46.26
|
D
|
|
|
NQ Stock Option (Right to Buy)
|
|
03/04/2023 |
Common Stock
|
14,187
|
48.98
|
D
|
|
| Explanation of Responses: |
|
|
|
| Remarks: |
Senior Vice President and President, Diagnostics
Exhibit List:
Exhibit 24 - Power of Attorney |
|
/s/ John L. Healy (POA on file) for Prahlad R. Singh |
10/03/2016 |
|
** 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). |
| 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. |
PerkinElmer, Inc.
Power of Attorney
The undersigned hereby constitutes and appoints each of Joel S. Goldberg
and John L. Healy, each signing singly and acting individually, the
undersigned's true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in the
undersigned's capacity as an officer and/or director of
PerkinElmer, Inc. (the "Company"), Forms 3, 4 and 5 (including
any amendments thereto) in accordance with Section 16(a) of the
Securities Exchange Act of 1935 (the "Exchange Act") and the
rules thereunder; and
(2) do and perform any and all acts for and on behalf of the
undersigned that may be necessary or desirable to prepare,
complete and execute any such Form 3, 4, or 5, or any amendment
thereto, and timely deliver and file such form or amendment with
the United States Securities and Exchange Commission and any
stock exchange or similar authority; and
(3) seek or obtain, as the undersigned's representative and on the
undersigned's behalf, information regarding transactions in the
Company's securities from any third party, including brokers,
employee benefit plan administrators, stock option
administrators, and trustees, and the undersigned hereby
authorizes any such person to release any such information to
such attorney-in-fact and approves and ratifies any such release
of information; and
(4) take any other action of any type whatsoever in connection with
the foregoing which, in the opinion of such attorney-in-fact,
may be of benefit to, in the best interest of, or legally
required by, the undersigned, it being understood that the
documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such
form and shall contain such terms and conditions as such
attorney-in-fact may approve in such attorney-in-fact's
discretion.
The undersigned hereby grants to each such attorney-in-fact full power
and authority to do and perform any and every act and thing whatsoever
requisite, necessary, or proper to be done in the exercise of any of the rights
and powers herein granted, as fully to all intents and purposes as the
undersigned might or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this power of attorney and the
rights and powers herein granted. The undersigned acknowledges that neither the
Company nor any of the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, assume (i) any liability for the
undersigned's responsibility to comply with the requirements of Section 16 of
the Exchange Act, (ii) any liability of the undersigned for any failure to
comply with such requirements, or (iii) any obligation or liability of the
undersigned for any profit disgorgement under Section 16(b) of the Exchange Act.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, or 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless superseded by a Power of Attorney dated after the date hereof or earlier
revoked by the undersigned in a signed writing delivered to the foregoing
attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed this 6th day of September, 2016.
/s/ Prahlad R. Singh
---------------------------------------
Signature
Prahlad R. Singh
----------------------------------------
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