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

(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 and CEO
3. Date of Earliest Transaction (Month/Day/Year)
09/10/2003
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 09/10/2003 M 15,918 A $20.9375 352,156 D
Common Stock, no par value 09/10/2003 F 5,918 D $56.315 346,238 D
Common Stock, no par value 140,523 I By Wife (1)
Common Stock, no par value 67,023 I By Wife as Trustee (2)
Common Stock, no par value 158,052 I As Co-Trustee (3)
Common Stock, no par value 792,963 I As Co-Trustee (4)
Common Stock, no par value 152,764 I By Partnership (5)
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
Stock Option $20.9375 09/10/2003 M 15,918 09/09/1999 03/09/2009 Common Stock 15,918 $20.9375 0 D
Explanation of Responses:
Remarks:
(1) I disclaim beneficial ownership of these shares. (2) 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. (3) Shares held in trusts of which I am a trustee and in which I and members of my immediate family are among the beneficiaries. (4) 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. (5) 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.
Douglas K. McClaine, Attorney-in-Fact for John T. Ryan III 09/12/2003
** 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.
rrd10212_11620.html POWER OF ATTORNEY To Sign and File Reports under Section 16(a) of the Securities Exchange Act of 1934, under Rule 144 or any other Filings Required Under the Federal Securities Laws With Respect to Securities of Mine Safety Appliances Company KNOW ALL MEN BY THESE PRESENTS, that the undersigned hereby constitutes and appoints Douglas K. McClaine or the General Counsel of Mine Safety Appliances Company ("MSA"), Dennis L. Zeitler or the Vice President-Finance of MSA and Nelson W. Winter, and each of them, his or her true and lawful attorneys-in-fact and agents, with full power of substitution, for the undersigned and in the undersigned's name, place and stead, to sign any and all reports of the undersigned under Section 16(a) of the Securities Exchange Act of 1934, under Rule 144 or any other filings required 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 attorneys-in-fact 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 the undersigned might or could do in person, hereby ratifying and confirming all th at said attorneys-in-fact 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 undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming any of the undersigned's responsibilities to comply with the Federal Securities Laws. This Power of Attorney shall remain in effect unless and until notice of its revocation shall have been filed by the undersigned with the Securities and Exchange Commission. IN WITNESS WHEREOF, the undersigned has executed and delivered this Power of Attorney the date set forth below. Date: August 27, 2002 SIGNATURE: /s/John T. Ryan III PRINT NAME: John T. Ryan III