Form 3 ROCKWELL AUTOMATION INC For: Mar 13 Filed by: Fooks Elik I
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March 15, 2017 6:49 PM EDT
| 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)
03/13/2017
|
3. Issuer Name
and
Ticker or Trading Symbol
ROCKWELL AUTOMATION INC
[
ROK
]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Senior 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 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
|
7,618.8046
(1)
|
D
|
|
|
Common Stock
|
3,104.8677
|
I
|
By savings plan
|
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 |
|
Employee Stock Option (Right to Buy)
|
12/03/2009 |
12/03/2018 |
Common Stock
|
6,000
|
29.37
|
D
|
|
|
Employee Stock Option (Right to Buy)
|
12/09/2010 |
12/09/2019 |
Common Stock
|
10,100
|
46.16
|
D
|
|
|
Employee Stock Option (Right to Buy)
|
12/07/2011 |
12/07/2020 |
Common Stock
|
7,100
|
69.57
|
D
|
|
|
Employee Stock Option (Right to Buy)
|
12/01/2012 |
12/01/2021 |
Common Stock
|
5,200
|
74.14
|
D
|
|
|
Employee Stock Option (Right to Buy)
|
12/06/2013 |
12/06/2022 |
Common Stock
|
4,000
|
80.11
|
D
|
|
|
Employee Stock Option (Right to Buy)
|
12/04/2014 |
12/04/2023 |
Common Stock
|
2,900
|
108.89
|
D
|
|
|
Employee Stock Option (Right to Buy)
|
12/02/2015 |
12/02/2024 |
Common Stock
|
4,300
|
115.69
|
D
|
|
|
Employee stock option (right to buy)
|
12/03/2016 |
12/03/2025 |
Common Stock
|
4,800
|
104.08
|
D
|
|
|
Employee Stock Option (Right to Buy)
|
12/06/2017 |
12/06/2026 |
Common Stock
|
3,400
|
136.4
|
D
|
|
|
Common Stock Share Equivalents
|
|
|
Common Stock
|
124.2341
|
0
(3)
|
I
|
By nonqualified savings plan
|
| Explanation of Responses: |
|
|
|
|
|
Karen A. Balistreri, Attorney-in-fact for Elik I. Fooks |
03/15/2017 |
|
** 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. |
power of attorney
I, Elik I. Fooks, appoint Rebecca W. House and Karen A.
Balistreri, signing singly, attorney-in-fact to:
(1) execute on my behalf a Form ID to apply for access
codes so that I am able to file SEC forms on EDGAR;
(2) execute on my behalf and in my capacity as an officer
of Rockwell Automation, Inc., a Delaware corporation
(the "Company"), Forms 3, 4 and 5 in accordance with
Section 16(a) of the Securities Exchange Act of 1934,
and Forms 144 under the Securities Act of 1933, and
the rules thereunder (the "Form" or "Forms");
(3) perform any and all acts on my behalf that may be
necessary or desirable to complete and execute any
Form and timely file such Form with the United States
Securities and Exchange Commission and any stock
exchange or similar authority; and
(4) take any other action 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 me, it being understood that
the documents executed by such attorney-in-fact on my
behalf 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 his or her
discretion.
I grant to each such attorney-in-fact full power and
authority to do and perform any act 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 I might or
could do if personally present. I ratify and confirm all that
such attorney-in-fact shall lawfully do by the rights and powers
granted by this Power of Attorney. Each attorney-in-fact shall
have full power of substitution or revocation.
I acknowledge that the attorneys-in-fact, in serving in
such capacity at my request, are not assuming, nor is the
Company assuming, any of my responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934.
This Power of Attorney will remain in full force and effect
until I am no longer required to file the Forms with respect to
my holdings of and transactions in securities issued by the
Company, unless I earlier revoke it in a signed writing
delivered to the Office of the Secretary of the Company for
distribution to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power
of Attorney to be executed as of this 2 day of March, 2017.
/s/ Elik I. Fooks
Elik I. Fooks
Office of the Secretary of the Co
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