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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) | $ 13.32 | 05/16/2005 | M | 7,736 | (7) | 05/22/2005 | Common Stock | 7,736 | (4) | 0 | D | ||||
Stock Option (Right to Buy) | $ 13.32 | 05/16/2005 | M | 64,264 | (7) | 05/22/2005 | Common Stock | 64,264 | (4) | 0 | I | Trust FBO Children | |||
Stock Option (Right to Buy) | $ 17.31 | 05/16/2005 | M | 72,000 | (7) | 05/22/2005 | Common Stock | 72,000 | (4) | 0 | I | Trust FBO Children |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MCCAUSLAND PETER C/O AIRGAS, INC. 259 N. RADNOR-CHESTER ROAD, SUITE 100 RADNOR, PA 19087 |
X | X | Chairman of the Board and CEO | |
MCCAUSLAND BONNIE F C/O AIRGAS, INC. 259 N. RADNOR-CHESTER ROAD, SUITE 100 RADNOR, PA 19087 |
X |
Todd R. Craun, Attorney-in-Fact for Peter McCausland | 05/18/2005 | |
**Signature of Reporting Person | Date | |
Todd R. Craun, Attorney-in-Fact for Bonnie F. McCausland | 05/18/2005 | |
**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) | Includes 15,700 shares owned directly by Peter McCausland and indirectly by Bonnie F. McCausland. |
(2) | Represents shares held in a trust for the benefit of the Reporting Persons' children. |
(3) | These shares of Arigas, Inc. common stock are held by the Reporting Persons' children in two separate trusts where each child is the settlor, beneficiary and a trustee of his or her respective trust. Neither of the Reporting Persons is a trustee of either trust. On May 3, 2005, each trust was amended to eliminate each child's power to vote, dispose of or direct the disposition of the shares held in trust. Each of the Reporting Persons disclaims beneficial ownership of these securities and this report shall not be deemed to be an admission that either of them is the beneficial owner of such securities. |
(4) | Not applicable. |
(5) | Includes 1,500 shares owned directly by Bonnie F. McCausland and indirectly by Peter McCausland. |
(6) | The information presented is as of 4/8/2005, the date of the latest available statement of the reporting person's holdings of Airgas, Inc. common stock in his 401(k) plan. Since 2/9/2005, the date relied upon for the amount reported on the reporting person's February 15, 2005 Form 4, a total of 512 shares have been acquired in transactions exempt from Section 16(b) by Rule 16b-3(c). |
(7) | These options are fully exercisable. |