# EDGAR Filing Document

**Accession Number:** 0001145197
**File Stem:** 0001127602-23-001064
**Filing Date:** 2023-1
**Character Count:** 7827
**Document Hash:** 3150218db902ecacb32201fad4897378
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001127602-23-001064.hdr.sgml**: 20230106

**ACCESSION NUMBER**: 0001127602-23-001064

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230104

**FILED AS OF DATE**: 20230106

**DATE AS OF CHANGE**: 20230106

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Petrovic Shacey
- **CENTRAL INDEX KEY:** 0001631895

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-33462
- **FILM NUMBER:** 23515072

**MAIL ADDRESS:**
- **STREET 1:** 600 TECHNOLOGY PARK DRIVE
- **STREET 2:** SUITE 200
- **CITY:** BILLERICA
- **STATE:** MA
- **ZIP:** 01821
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** INSULET CORP
- **CENTRAL INDEX KEY:** 0001145197
- **STANDARD INDUSTRIAL CLASSIFICATION:** SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
- **IRS NUMBER:** 043523891
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 100 NAGOG PARK
- **CITY:** ACTON
- **STATE:** MA
- **ZIP:** 01720
- **BUSINESS PHONE:** 978-600-7000

**MAIL ADDRESS:**
- **STREET 1:** 100 NAGOG PARK
- **CITY:** ACTON
- **STATE:** MA
- **ZIP:** 01720

### 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>Petrovic Shacey<br><sub>(Last) (First) (Middle)</sub><br>C/O INSULET CORPORATION<br>100 NAGOG PARK<br><sub>(Street)</sub><br>ACTON, MA 01720<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-01-04 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>INSULET CORP [ PODD ] | **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 | 2023-01-04 |  | M |  | 10445<sup>(1)</sup> | A | $46.22 | 25234 | D |  |
| Common Stock | 2023-01-04 |  | M |  | 4555<sup>(1)</sup> | A | $74.50 | 29789 | D |  |
| Common Stock | 2023-01-04 |  | S |  | 15000<sup>(1)</sup> | D | 281.88<sup>(2)(3)</sup> | 14789 | D |  |
| Common Stock |  |  |  |  |  |  |  | 73205 | I | By NG Trust |

---

## 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 |
| Employee Stock Option (Right to Buy) | $46.22 | 2023-01-04 |  | M |  |  | 10445 | <sup>(4)</sup> | 2027-02-22 | Common Stock | 10445 | $0 | 0 | D |  |
| Employee Stock Option (Right to Buy) | $74.50 | 2023-01-04 |  | M |  |  | 4555 | <sup>(4)</sup> | 2028-02-14 | Common Stock | 4555 | $0 | 11838 | D |  |

---

### Footnotes:

(1) The transactions reported in this Form 4 were effected pursuant to an existing Rule 10b5-1 trading plan.

(2) The price reported represents the weighted average sale price of the shares sold. The shares were sold at varying prices in the range of $278.63 to $289.70. Specifically: 3,144 shares were sold in the range of $278.63 to $279.62, with a weighted average share price of $279.20; 2,556 shares were sold in the range of $279.65 to $280.59, with a weighted average share price of $280.05; 2,337 shares were sold in the range of $280.66 to $281.39, with a weighted average share price of $281.13; 2,775 shares were sold in the range of $281.67 to $282.55, with a weighted average share price of $282.17;

(3) Footnote continued:898 shares were sold in the range of $282.73 to $283.68, with a weighted average share price of $283.33; 1,184 shares were sold in the range of $283.78 to $284.53, with a weighted average share price of $284.06; 700 shares were sold in the range of $284.82 to $285.18, with a weighted average share price of $284.89; 800 shares were sold in the range of $286.44 to $286.79, with a weighted average share price of $286.66;  300 shares were sold in the range of $287.68 to $288.45, with a weighted average share price of $288.10; 306 shares were sold in the range of $289.25 to $289.70, with a weighted average share price of $289.38.  The Reporting Person hereby undertakes, upon request of the Staff of the U.S. Securities Exchange Commission, the Issuer or a security holder of the Issuer, to provide full information regarding the number of shares sold at each separate price.

(4) This option is subject to a four-year vesting period with 25% of the total award vesting one year after the grant date and the remainder vesting in equal quarterly installments each quarter thereafter for 12 quarters, subject to continued employment.

**Signature:** /s/ Patricia K. Dolan, attorney-in-fact  
**Date:** 2023-01-06

### 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.**