# EDGAR Filing Document

**Accession Number:** 0001524472
**File Stem:** 0001562180-23-002452
**Filing Date:** 2023-3
**Character Count:** 9324
**Document Hash:** 129bec5d6ffb2b7ee7665cc24c2e4e14
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001562180-23-002452.hdr.sgml**: 20230303

**ACCESSION NUMBER**: 0001562180-23-002452

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 2

**CONFORMED PERIOD OF REPORT**: 20230301

**FILED AS OF DATE**: 20230303

**DATE AS OF CHANGE**: 20230303

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Capers Dorothy Trefon
- **CENTRAL INDEX KEY:** 0001905353

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-35229
- **FILM NUMBER:** 23706896

**MAIL ADDRESS:**
- **STREET 1:** XYLEM INC.
- **STREET 2:** 1 INTERNATIONAL DRIVE
- **CITY:** RYE BROOK
- **STATE:** NY
- **ZIP:** 10573
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Xylem Inc.
- **CENTRAL INDEX KEY:** 0001524472
- **STANDARD INDUSTRIAL CLASSIFICATION:** PUMPS & PUMPING EQUIPMENT [3561]
- **IRS NUMBER:** 452080495
- **STATE OF INCORPORATION:** IN
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 301 WATER STREET SE
- **CITY:** WASHINGTON
- **STATE:** DC
- **ZIP:** 20003
- **BUSINESS PHONE:** 202-869-9150

**MAIL ADDRESS:**
- **STREET 1:** 301 WATER STREET SE
- **CITY:** WASHINGTON
- **STATE:** DC
- **ZIP:** 20003

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** ITT WCO, Inc.
- **DATE OF NAME CHANGE:** 20110628

## Ex-24

```

POWER OF ATTORNEY

The undersigned, Dorothy Capers, does hereby nominate constitute and
appoint each of Kelly O'Shea, Juliene Patton, Callie Plant and Dorothy Capers
as his/her/their true and lawful attorneys and agents to do any and all acts
and things and execute and file any and all instruments which said attorneys
and agents may deem necessary or advisable to enable the undersigned (in his/
her/their individual capacity or in any other capacity) to comply with the
Securities Exchange Act of 1934 (the "34 Act") and the Securities Act of 1933
(the "33 Act") and any requirements of the Securities and Exchange Commission
(the "SEC") in respect thereof, in connection with the preparation, execution
and/or filing of (i) any report or statement of beneficial ownership or changes
in beneficial ownership of securities of Xylem Inc., an Indiana corporation
(the "Company"), that the undersigned (in his/her/their individual capacity or
in any other capacity) may be required to file pursuant to Section 16(a) of the
34 Act, including any repo rt or statement on Form 3, Form 4 or Form 5, or to
any amendment thereto, (ii) any report or notice required under Rule 144 of the
33 Act, including Form 144, or any amendment thereto relating to the
undersigned's role with, or beneficial ownership of, the Company's securities,
and (iii) any and all other documents or instruments that may be necessary or
desirable in connection with or in furtherance of any of the foregoing,
including Form ID, or any amendments thereto, and any other documents necessary
or appropriate to obtain codes and passwords enabling the undersigned to make
electronic filings with the SEC of reports required pursuant to Section 16(a)
of the 34 Act or any rule or regulation of the SEC, such power and authority to
extend to any form or forms adopted by the SEC in lieu of or in addition to any
of the foregoing and to include full power and authority to sign the
undersigned's name in his/her/their individual capacity or otherwise, hereby
ratifying and confirming all that said attorneys and agents, or any of them,
shall do or cause to be done by virtue thereof.

This authorization shall supersede all prior authorizations to act for the
undersigned with respect to securities of the Company in such matters, which
prior authorizations are hereby revoked, and shall remain in effect until the
undersigned is no longer required to file Form 3, 4 or 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company
unless earlier revoked, by the undersigned in a signed writing delivered to the
foregoing attorneys in fact.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of November 2022.

_____________________________
/s/ Dorothy Capers

```

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Capers Dorothy Trefon<br><sub>(Last) (First) (Middle)</sub><br>C/O XYLEM, INC.<br>301 WATER STREET SE<br><sub>(Street)</sub><br>WASHINGTON, DC 20003<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-03-01 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_SVP & General Counsel_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Xylem Inc. [ XYL ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2023-03-01 |  | F |  | 484.00<sup>(1)</sup> | D | $101.09 | 3622.00 | D |  |
| Common Stock | 2023-03-01 |  | A |  | 1793.00<sup>(2)</sup> | A | $0.00 | 5415.00 | D |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Stock Option (Right to Buy) | $101.09 | 2023-03-01 |  | A |  | 6237.00 |  | <sup>(3)</sup> | 2033-03-01 | Common Stock | 6237.00 | $101.09 | 6237.00 | D |  |

---

### Footnotes:

(1) Reflects units withheld to pay the tax liability incident to the vesting of restricted stock units granted on March 1, 2021 (198) and March 1, 2022 (286) under the Xylem 2011 Omnibus Incentive Plan (Amended and Restated February 24, 2016).

(2) Reflects an award of restricted stock units pursuant to the Xylem 2011 Omnibus Incentive Plan (Amended and Restated February 24, 2016) that are scheduled to vest in one third increments on March 1, 2024, March 1, 2025 and March 1, 2026.

(3) Reflects an award of non-qualified stock options pursuant to the Xylem 2011 Omnibus Incentive Plan (Amended and Restated February 24, 2016) that are scheduled to vest in one-third increments on March 1, 2024, March 1, 2025 and March 1, 2026.

**Signature:** /s/ Callie Plant, by power of attorney for Dorothy T. Capers  
**Date:** 2023-03-03

### Remarks:

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.**