SEC FORM 3 SEC Form 3
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
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1. Name and Address of Reporting Person*
Kurburski Jeffrey L.

(Last) (First) (Middle)
855 EAST MAIN

(Street)
ZEELAND MI 49464

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/08/2018
3. Issuer Name and Ticker or Trading Symbol
MILLER HERMAN INC [ MLHR ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP Chief Information Officer
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 6,449 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
Non-Qualified Stock Option (right to buy) 07/19/2019 07/19/2026 Common Stock 11,114 31.86 D
Non-Qualified Stock Option (right to buy) (1) 07/18/2027 Common Stock 9,324 33.75 D
Restricted Stock Units 07/19/2019(3) (3) Common Stock 1,836 (2) D
Restricted Stock Units 07/18/2020(3) (3) Common Stock 1,765 (2) D
Restricted Stock Units 02/09/2020(4) (4) Common Stock 7,695 (2) D
Restricted Stock Units 07/16/2021(3) (3) Common Stock 1,904 (2) D
Explanation of Responses:
1. This option was granted on 07/18/2017 and vests in three equal annual installments beginning on the first anniversary of the grant date.
2. Each restricted stock unit represents a contingent right to receive one share of MLHR common stock.
3. The restricted stock units have a three year cliff vest.
4. The restricted stock units have a two year cliff vest.
By: Angela M. Shamery For: Jeffrey L. Kurburski 10/12/2018
** 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 5 (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.
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