SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
RYAN JOHN T III

(Last) (First) (Middle)
121 GAMMA DRIVE
RIDC INDUSTRIAL PARK

(Street)
PITTSBURGH PA 15238

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MINE SAFETY APPLIANCES CO [ MSA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chairman & CEO
3. Date of Earliest Transaction (Month/Day/Year)
02/21/2007
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock, no par value 02/21/2007 A 7,914 A $0 981,538 D
Common Stock, no par value 02/23/2007 G V 6,204 D $0 975,334 D
Common Stock, no par value 02/23/2007 G V 1,748 D $0 352,517 I By Wife(1)
Preferred - 4-1/2% Cumulative 187 D
Common Stock, no par value 1,521,889 I As Co-Trustee(2)
Common Stock, no par value 147,574 I By Partnership(3)
Preferred - 4-1/2% Cumulative 93 I By Testamentary Trust(4)
Common Stock, no par value 160,357 I By Wife as Trustee(5)
Common Stock, no par value 474,156 I Co-Trustee(6)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Incentive Stock Option $44.105 02/21/2007 A 2,494 02/21/2010 02/21/2012 Common Stock, no par value 2,494 $44.105 2,494 D
Non-statutory Stock Option $0(7) 02/21/2007 A 50,680 02/21/2010 02/21/2017 Common Stock, no par value 50,680 $40.095 50,680 D
Explanation of Responses:
1. I disclaim beneficial ownership of these shares.
2. Shares held in a trust of which I am a Trustee and in which a member of my immediate family is the beneficiary. I disclaim beneficial ownership of these shares.
3. Shares held by a family limited partnership of which I am a general partner and the other partners include members of my immediate family. I disclaim beneficial ownership of these shares except to the extent of my pecuniary interest.
4. Shares held in a testamentary trust of which I am not a trustee, in which my proportionate interest as an income beneficiary is represented by a 1/6 interest.
5. Shares held in trusts of which I am not a trustee and in which members of my immediate family are beneficiaries. I disclaim beneficial ownership of these shares.
6. Shares held in trusts of which I am a trustee and in which I and members of my immediate family are among the beneficiaries.
7. Conversion price is $40.095.
Remarks:
Douglas K. McClaine, Attorney in Fact 02/23/2007
** 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 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.