# EDGAR Filing Document

**Accession Number:** 0000922621
**File Stem:** 0001127602-23-010860
**Filing Date:** 2023-3
**Character Count:** 8742
**Document Hash:** 76db04d4711d86b5fbf1f3f1b4034065
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001127602-23-010860.hdr.sgml**: 20230320

**ACCESSION NUMBER**: 0001127602-23-010860

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230317

**FILED AS OF DATE**: 20230320

**DATE AS OF CHANGE**: 20230320

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Hagen Thomas B
- **CENTRAL INDEX KEY:** 0001396809

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 000-24000
- **FILM NUMBER:** 23746771

**MAIL ADDRESS:**
- **STREET 1:** 230 WEST 6TH STREET
- **CITY:** ERIE
- **STATE:** PA
- **ZIP:** 16507-1319
**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

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Hagen Thomas B<br><sub>(Last) (First) (Middle)</sub><br>230 WEST 6TH STREET<br><sub>(Street)</sub><br>ERIE, PA 16507-1319<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-03-17 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>ERIE INDEMNITY CO [ ERIE ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Class A Common Stock |  |  |  |  |  |  |  | 5100 | D |  |
| Class A Common Stock |  |  |  |  |  |  |  | 12230 | I | Estate of Susan H. Hagen<sup>(1)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 10086059 | I | Family L.P.<sup>(2)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 6658800 | I | Susan Hagen Estate Settlement Trust<sup>(1)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Class B Common Stock | 0<sup>(3)</sup> |  |  |  |  |  |  | <sup>(3)</sup> | <sup>(3)</sup> | Class A Common Stock | 9600 |  | 4 | D |  |
| Class B Common Stock | 0<sup>(3)</sup> |  |  |  |  |  |  | <sup>(3)</sup> | <sup>(3)</sup> | Class A Common Stock | 28800 |  | 12 | I | Susan Hagen Estate Settlement Trust<sup>(1)</sup> |
| Directors' Deferred Compensation Share Credits | 0<sup>(4)</sup> |  |  |  |  |  |  | <sup>(5)</sup> | <sup>(5)</sup> | Class A Common Stock | 12993.621 |  | 12993.621 | D |  |
| Class B Common Stock | 0<sup>(3)</sup> | 2023-03-17 |  | P |  | 20 |  | <sup>(3)</sup> | <sup>(3)</sup> | Class A Common Stock | 48000 | $818206.68 | 173 | I | Family L.P.<sup>(2)</sup> |

---

### Footnotes:

(1) These shares were owned by Erie Indemnity Company director and reporting person, Susan Hirt Hagen who died 6/15/15.  By operation of law, her 6,658,800 Class A shares and 12 Class B shares held in a revocable trust passed to an irrevocable trust of which this reporting person became co-trustee, sharing voting and investment powers.  The 12,230 Class A shares from Mrs. Hagen's Directors' Deferred Compensation Plan account were subsequently transferred by the Company to her estate for which this reporting person is co-executor, sharing voting and investment powers. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose.

(2) These shares are held by the Hagen FLP of which the reporting person is a Limited Partner and the General Partner with the sole powers of investment and voting.  The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose.

(3) 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.  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.

(4) Conversion price is not applicable to shares granted under the Outside Directors' Deferred Compensation Plan.

(5) The shares subject to this reporting are Share Credits which are periodically credited to the accounts of certain Directors of Erie Indemnity Company pursuant to its Outside Directors' Stock Plan. These Share Credits represent the right to receive an equivalent number of shares of Erie Indemnity Company Class A common stock when the reporting individual's service as a Director of the Company ends.  There are no exercisable or expiration dates for these securities.

**Signature:** Rebecca A. Buona, Power of Attorney  
**Date:** 2023-03-20

### Remarks:

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 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).

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.**