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)
| 2. Date of Event Requiring Statement (Month/Day/Year) 12/01/2020 | 3. Issuer Name and Ticker or Trading Symbol HNI CORP [ HNI ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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) |
Common Stock | 3,174.18 | D | |
Common Stock | 583.514 | I | Profit-Sharing Retirement Plan |
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 | ||||
Non-qualifying employee stock options (right to buy) | 02/18/2019(1) | 02/18/2025 | Common Stock | 676 | 51.54 | D | |
Non-qualifying employee stock options (right to buy) | 02/17/2020(1) | 02/17/2026 | Common Stock | 1,769 | 32.03 | D | |
Non-qualifying employee stock options (right to buy) | 02/15/2021(2) | 02/15/2027 | Common Stock | 2,227 | 46.62 | D | |
Non-qualifying employee stock options (right to buy) | 02/15/2020(3) | 02/15/2027 | Common Stock | 7,500 | 46.62 | D | |
Non-qualifying employee stock options (right to buy) | 02/14/2022(2) | 02/14/2028 | Common Stock | 4,877 | 38.68 | D | |
Non-qualifying employee stock options (right to buy) | 02/13/2023(2) | 02/13/2029 | Common Stock | 12,175 | 39.77 | D | |
Performance Standard Units | 12/31/2022 | (4) | Common Stock | 2,590 | 0.0 | D | |
Restricted Stock Units | 08/07/2018 | (5) | Common Stock | 2,322 | 0.0 | D | |
Restricted Stock Units | 02/12/2020 | (6) | Common Stock | 2,590 | 0.0 | D |
Explanation of Responses: |
1. The option became fully vested and exercisable in one installment on the fourth anniversary of the grant date. |
2. The option will become fully vested and exercisable in one installment on the fourth anniversary of the grant date. |
3. The option became fully vested and exercisable in one installment on the third anniversary of the grant date. |
4. On February 12, 2020, the reporting person was granted performance standard units to become fully vested on December 31, 2022. These shares will not be distributed until after HNI Corporation's February 2023 Board Meeting and only upon achievement of performance goals. |
5. On August 7, 2018, the reporting person was granted restricted stock units, vesting in two equal installments beginning on the first anniversary of the grant date. The first installment of 2,323 units fully vested on August 7, 2020. The second installment of 2,322 units will vest on August 7, 2021. |
6. On February 12, 2020, the reporting person was granted restricted stock units, vesting one-third per year in equal installments beginning on the first anniversary of the grant date. |
Remarks: |
Exhibit List: Exhibit 24-1 Power of Attorney |
/s/ Jason D. Hagedorn | 12/11/2020 | |
** 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. |