SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 04/06/2022 |
3. Issuer Name and Ticker or Trading Symbol
CHASE CORP [ CCF ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Chase Corporation Common Stock | 283,359(1)(2) | I | Peter R. Chase Insurance Trust |
Chase Corporation Common Stock | 44,038(3)(4) | I | Peter R. Chase Trust |
Chase Corporation Common Stock | 1,470(5) | I | Chase 2015 Irrevocable Trust |
Chase Corporation Common Stock | 260,357(6)(7) | D | |
Chase Corporation Common Stock | 22,538(8) | I | Peter R. Chase Insurance Trust - GST Exempt |
Chase Corporation Common Stock | 17,359(9)(10) | I | Peter R. Chase 2022 Qualified Annuity Trust #1 |
Chase Corporation Common Stock | 61,398(11) | I | Peter R. Chase 2022 Qualified Annuity Trust #2 |
Chase Corporation Common Stock | 150,000(12) | I | Peter R. Chase 2022 Qualified Annuity Trust #3 |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. Represents shares held by the Peter R. Chase Insurance Trust. |
2. Total represents exempt transfers of shares made on April 6, 2022 and May 18, 2022 from the Peter R. Chase 2020 Qualified Annuity Trust #1 and the Peter R. Chase 2020 Qualified Annuity Trust #2, respectively, to the Peter R. Chase Insurance Trust. |
3. Represents shares held by the Peter R. Chase Trust. |
4. Total represents exempt transfer of shares held by the Peter R. Chase 2022 Qualified Annuity Trust #1 to the Peter R. Chase Trust. |
5. Represents shares held by the Chase 2015 Irrevocable Trust. |
6. Total represents exempt transfers made between April 21, 2022 and June 28, 2023 from the Peter R. Chase 2021 Qualified Annuity Trust #2; the Peter R. Chase 2020 Qualified Annuity Trust #2; the Peter R. Chase 2021 Qualified Annuity Trust #3; the Peter R. Chase 2021 Qualified Annuity Trust #1 and the Peter R. Chase 2022 Qualified Annuity Trust #2 to the Peter R. Chase Individual account. |
7. Total represents exempt transfers made on May 18, 2022 and July 27, 2022 from the Peter R. Chase Individual account to fund the Peter R. Chase 2022 Qualified Annuity Trust #2; and the Peter R. Chase 2022 Qualified Annuity Trust #3 respectively. |
8. Represents shares held by the Peter R. Chase Insurance Trust - GST Exempt. |
9. Represents shares held by the Peter R. Chase 2022 Qualified Annuity Trust #1. |
10. Total represents exempt transfer of shares from the Peter R. Chase 2022 Qualified Annuity Trust #1 to the Peter R. Chase Trust. |
11. Represents exempt transfer of shares held by the Peter R. Chase Individual Account to/from the Peter R. Chase 2022 Qualified Annuity Trust #2. |
12. Represents exempt transfer of shares held by the Peter R. Chase Individual Account to the Peter R. Chase 2022 Qualified Annuity Trust #3. |
Paula M. Myers, By Power of Attorney | 07/26/2023 | |
** 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 5 (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 Number. |