-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, S4U9Z+JAgB8l52pRND6WYfzGkpZpJkVU7cKToksyjLDlfugKywIyZrSkJxyMfK9A /09ZeMhVC0E2cxp8+sEOZw== 0001177103-06-000033.txt : 20060125 0001177103-06-000033.hdr.sgml : 20060125 20060125092103 ACCESSION NUMBER: 0001177103-06-000033 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20060123 FILED AS OF DATE: 20060125 DATE AS OF CHANGE: 20060125 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HAGEN SUSAN HIRT CENTRAL INDEX KEY: 0001100591 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24000 FILM NUMBER: 06548051 BUSINESS ADDRESS: BUSINESS PHONE: 8144550370 MAIL ADDRESS: STREET 1: C/O ROGER W RICHARDS STREET 2: 100 STATE STREET - STE 440 CITY: ERIE STATE: PA ZIP: 16507-1456 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ERIE INDEMNITY CO CENTRAL INDEX KEY: 0000922621 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 250466020 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 ERIE INSURANCE PL CITY: ERIE STATE: PA ZIP: 16530 BUSINESS PHONE: 8148702000 MAIL ADDRESS: STREET 1: 100 ERIE INSURANCE PLACE CITY: ERIE STATE: PA ZIP: 16530 4 1 hag847.xml X0202 4 2006-01-23 0 0000922621 ERIE INDEMNITY CO ERIE 0001100591 HAGEN SUSAN HIRT 100 STATE STREET, SUITE 440 ERIE PA 16507 1 0 0 0 Class A Common Stock 6658800.0000 D Directors' Deferred Compensation Phantom Units 2006-01-23 4 J 0 17.929 0 A Class A Common Stock 17.9290 2233.7005 D Class B Common Stock 0.0000 Class A Common Stock 28800.0000 12.0000 D Class B Common Stock 0.0000 Class A Common Stock 2808000.0000 1170.0000 I Beneficiary & Trustee, Trust Class B Common Stock 0.0000 Class A Common Stock 2808000.0000 1170.0000 I Contingency Beneficiary & Trustee, Trust 6,658,500 of these shares are held in a Grantor and Beneficiary, Revocable Trust Reporting person and her husband, Thomas B. Hagen, are limited partners of the Hagen Family Limited Partnership which holds 10,092,900 Class A non-voting shares and 1 Class B voting share. Mr. Hagen is the only general partner of the partnership having sole voting power and investment power over the shares held by the partnership, and the reporting person disclaims beneficial ownership of those shares. Conversion price is not applicable to shares granted under the Outside Directors' Deferred Compensation Plan. Acquired under dividend reinvestment for Directors' Deferred Compensation Plan The 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. The 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. Each share of Class B Common Stock is convertible at any time into 2,400 shares of Class A Common 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. Pursuant 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. By: Linda A. Etter, Power of Attorney 2006-01-25 -----END PRIVACY-ENHANCED MESSAGE-----