SEC Form 4 · accession 0001127602-17-030723

ERIE INDEMNITY CO · ERIE

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).

Reporting owner

Jonathan Hirt Hagen

Director

Period of report

Nov 1, 2017

Accepted (ET)

Nov 1, 2017 · 2:41 pm EDT

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	—	—		—	223,130	D
Class A Common Stock^F1	holding	—	—		—	200	I	See Footnote

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 Units^F2,F4,F5	$0.00	Nov 1, 2017	J	121	A	—	—	Class A Common Stock	121	11,666	D
Class B Common Stock^F6	$0.00	holding	—	—	—	—	—	Class A Common Stock	2,400	1	D
Class B Common Stock^F6	$0.00	holding	—	—	—	—	—	Class A Common Stock	2,808,000	1,170	I
Class B Common Stock^F6	$0.00	holding	—	—	—	—	—	Class A Common Stock	2,808,000	1,170	I

Explanation of responses

F1Held by family member. The Reporting Person disclaims beneficial ownership of these reported securities and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for the purposes of Section 16 or for any other purpose.
F2Conversion price is not applicable to shares granted under the Outside Directors' Deferred Compensation Plan.
F3Acquired under Directors' Deferred Compensation Plan
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 exercisable date for these securities.
F5The 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.
F6Pursuant to the Articles of Incorporation of the Company, as amended, shares of Class B Common Stock (voting) of Erie Indemnity Company are convertible at any time to shares of Class A Common Stock (non-voting) at a conversion rate of 2,400 shares of Class A Stock for each share of Class B Stock. There are no exercise or expiration dates associated with this conversion feature and no specific exercise price when a Class B share is converted into Class A shares.