SEC Form 4 · accession 0001127602-17-002277
ERIE INDEMNITY CO · ERIE
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
J Ralph Borneman Jr.
Director
Period of report
Jan 23, 2017
Accepted (ET)
Jan 24, 2017 · 2:46 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000922621
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class A Common Stock | holding | — | — | — | 50,000 | I | J. Ralph Borneman, Jr. TTEE J. Ralph Borneman, Jr. Revocable Trust DTD 02/16/2015 |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Directors' Deferred Compensation Phantom UnitsF1,F3,F4 | $0.00 | Jan 23, 2017 | J | 97 | A | — | — | Class A Common Stock | 97 | 13,702 | D |
Explanation of responses
- F1Conversion price is not applicable to shares granted under the Outside Directors' Deferred Compensation Plan.
- F2Acquired under dividend reinvestment for Directors' Deferred Compensation Plan.
- F3The shares subject to this reporting are phantom Share Credits which are periodically credited to the accounts of certain Directors of Erie Indemnity Company pursuant to its Outside Directors Stock Plan. These Credit Shares are actually paid to the reporting individual in shares of Erie Indemnity Company Class A Common Stock when their service as a Director of Erie Indemnity Company ends. There is no exercisable date for these securities.
- F4The shares subject to this reporting are phantom Share Credits which are periodically credited to the accounts of certain Directors of Erie Indemnity Company pursuant to its Outside Directors Stock Plan. These Credit Shares are actually paid to the reporting individual in shares of Erie Indemnity Company Class A Common Stock when their service as a Director of Erie Indemnity Company ends. There is no expiration date for these securities.