Statement of Changes in Beneficial Ownership (4)
16 March 2023 - 05:42AM
Edgar (US Regulatory)
FORM 4
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0287
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hours per response... 0.5 |
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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 * Feltz Lorianne |
2. Issuer Name and Ticker or Trading
Symbol ERIE INDEMNITY CO [ ERIE ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Executive Vice President |
(Last)
(First)
(Middle)
100 ERIE INSURANCE PLACE |
3. Date of Earliest Transaction (MM/DD/YYYY)
3/14/2023
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(Street)
ERIE, PA 16530
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Class A Common Stock |
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|
|
|
|
|
|
4929.139 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
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1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of derivative Securities Beneficially
Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Incentive Compensation Deferral Plan Share
Credits |
$0 (1) |
3/14/2023 |
|
J (2) |
|
66.157 |
|
(3) |
(3) |
Class A Common Stock |
66.157 |
$232.86 |
2614.186 |
D |
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Explanation of
Responses: |
(1) |
Conversion price is not
applicable to shares granted under the Erie Indemnity Company
Incentive Compensation Deferral Plan. |
(2) |
Acquired under the Erie
Indemnity Company Incentive Compensation Deferral Plan from an
Annual Incentive Plan award. |
(3) |
The shares subject to this
reporting are Share Credits which are periodically credited to the
accounts of a select group of management and highly compensated
employees of Erie Indemnity Company pursuant to its Incentive
Compensation Deferral Plan. ??These Share Credits represent the
right to receive an equivalent number of shares of Erie Indemnity
Company Class A common stock when the reporting individual retires
or otherwise separates from service with the Company.? There are no
exercisable or expiration dates for these securities. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Feltz Lorianne
100 ERIE INSURANCE PLACE
ERIE, PA 16530 |
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|
Executive Vice President |
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Signatures
|
Rebecca A. Buona, Power of
Attorney |
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3/15/2023 |
**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 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 control number. |
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