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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 |
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 | Executive Chariman | |
MCCAUSLAND BONNIE F ERDENHEIM FARM P.O. BOX 274 LAFAYETTE HILL, PA 19444 |
X |
Robert H. Young, Jr., Attorney-in-Fact for Peter McCausland | 11/28/2012 | |
**Signature of Reporting Person | Date | |
Robert H. Young, Jr., Attorney-in-Fact for Bonnie F. McCausland | 11/28/2012 | |
**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 shares of Airgas, Inc. common stock jointly owned by Peter McCausland and Bonnie McCausland, except for 15,700 shares that are directly owned by Peter McCausland and indirectly owned by Bonnie McCausland. |
(2) | Represents shares of Airgas, Inc. common stock held in two separate GRATs of which Peter McCausland and Bonnie McCausland are co-trustees and either he or she is a beneficiary. |
(3) | The information presented is as of 10/24/2012. Since 3/31/2012, the date of the statement relied upon for the amount reported on Peter McCausland's Form 5 dated 5/14/2012, a total of 418 shares of common stock have been acquired in Peter McCausland's 401(k) plan through transactions exempt under Section 16(b). |
(4) | Represents shares of Airgas, Inc. common stock owned directly by Bonnie McCausland and indirectly by Peter McCausland. |