SEC Form 5 · accession 0001127602-18-006030

ERIE INDEMNITY CO · ERIE

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

Reporting owner

Eugene C Connell

Director

Period of report

Dec 31, 2017

Accepted (ET)

Feb 14, 2018 · 2:49 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^F2	Jul 20, 2017	J	15	$126.07	A	2,445	I	By Children
Class A Common Stock^F2	Oct 20, 2017	J	15	$124.55	A	2,445	I	By Children
Class A Common Stock	holding	—	—		—	17,244	D

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^F3,F4,F5	$0.00	holding	—	—	—	—	—	Class A Common Stock	247	247	D

Explanation of responses

F1This Form 5 is being filed to report a de minimus transaction of additional shares acquired pursuant to a dividend reinvestment plan in the brokerage accounts of the Reporting Person's children.
F2Shares held by Reporting Person's children living in his household. The Reporting Person disclaims beneficial ownership of these reported securities, therefore 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.
F3Conversion price is not applicable to shares granted under the Outside 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.