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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Option (Right to Buy) | $ 11.5 | 12/11/2008 | M | 130,000 | (7) | 05/18/2009 | Common Stock | 130,000 | (2) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MCCAUSLAND PETER C/O AIRGAS, INC. 259 N. RADNOR-CHESTER RD, STE. 100 RADNOR, PA 19087 |
X | X | Chariman, President and CEO |
Robert H. Young, Jr., Attorney-in-Fact for Peter McCausland | 12/15/2008 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Represents 22,000 shares of Airgas, Inc. common stock distributed to Peter McCausland and his spouse (and held jointly) from two separate grantor retained annuity trusts (each, a "GRAT") of which Peter McCausland is a co-trustee with his spouse and either he or his spouse is a beneficiary. |
(2) | Not applicable. |
(3) | Includes 15,700 shares of Airgas, Inc. common stock owned directly by Peter McCausland and indirectly by his spouse. |
(4) | Represents 228,000 shares of Airgas, Inc. common stock held in two separate GRATs of which Peter McCausland is a co-trustee and either he or his spouse is a beneficiary. |
(5) | Represents 41,500 shares of Airgas, Inc. common stock owned directly by his spouse and indirectly by Peter McCausland. |
(6) | The information presented is as of 12/11/2008, the date of the latest available statement of the reporting person's holdings of Airgas, Inc. common stock in his 401(k) plan. Since March 7, 2008, the date of the statement relied upon for the amount reported on the reporting person's Form 4 dated March 11, 2008, a total of 735 shares of common stock have been acquired in the reporting person's 401(k) plan through transactions exempt under Section 16(b). |
(7) | These options became exercisable in 25% equal increments on each of 5/18/2000, 5/18/2001, 5/18/2002 and 5/18/2003. |