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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| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Estimated average burden |
| hours per response: |
0.5 |
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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*
| 1000 CRANBERRY WOODS DRIVE |
|
(Street)
| CRANBERRY WOODS TOWNSHIP |
PA |
16066 |
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2. Issuer Name and Ticker or Trading Symbol
MSA Safety Inc
[ MSA ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
|
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3. Date of Earliest Transaction
(Month/Day/Year)
09/10/2023
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Rule 10b5-1(c) Transaction Indication |
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Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10. |
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
|---|
| 1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
Amount |
(A) or (D) |
Price |
| Common Stock, no par value |
09/10/2023 |
|
A |
|
2.556 |
A |
$0.0000
|
6,318.556 |
D |
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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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 |
| Explanation of Responses: |
| Remarks: |
|
|
Richard W. Roda, Attorney in Fact |
09/12/2023 |
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** 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. |
POWER OF ATTORNEY
To Sign and File Reports under Section 16a
of the Securities Exchange Act of 1934
under Rule 144 or any other Filings Required
including Form ID and Schedule 13D
Under the Federal Securities Laws
With Respect to Securities of MSA Safety Incorporated
This Power of Attorney is being executed for and on behalf of
Sandra Phillips Rogers the Grantor pursuant to the full power of
substitution provided by the Grantor in the Grantors original Power of
Attorney dated February 26 2020 that appointed the undersigned among
others as the Grantors attorneyinfact
KNOW ALL MEN BY THESE PRESENTS that the undersigned as the
Grantors attorneyinfact hereby exercises the undersigneds full power
of substitution and substitutes constitutes and appoints Richard W Roda
Lee B McChesney and Jeffrey G Aromatorio and each of them as
Grantors true and lawful attorneysinfact and agents with full power of
substitution for Grantor and in the Grantors name place and stead to
sign any and all reports of the undersigned under Section 16a of the
Securities Exchange Act of 1934 under Rule 144 or any other filings
required including Form ID and Schedule 13D under the Federal Securities
Laws with respect to securities of MSA and to file the same with the
Securities and Exchange Commission granting unto said attorneysinfact
and agents and each of them full power and authority to do and perform
each and every act and thing requisite and necessary to be done as fully
to all intents and purposes as Grantor might or could do in person hereby
ratifying and confirming all that said attorneysinfact and agents or any
of them or his her or their substitute or substitutes may lawfully do
or cause to be done by virtue hereof The Grantor acknowledges that the
foregoing attorneysinfact in serving in such capacity at the request of
the Grantor are not assuming any of the Grantors responsibilities to
comply with the Federal Securities Laws
This Power of Attorney shall remain in effect unless it is
revoked in writing by the Grantor or if earlier as it relates to filing
Forms 3 4 and 5 with respect to the Grantors holdings of and
transactions in securities issued by MSA until the Grantor is no longer
required to file such Forms 3 4 and 5
IN WITNESS WHEREOF the undersigned has executed and delivered
this Power of Attorney the date set forth below
Date August 1 2023
SIGNATURE
PRINT NAME Stephanie L Sciullo
Attorney in fact for Grantor
Exhibit 24
