Form 4 HNI CORP For: Sep 01 Filed by: BELL MARY H
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E-mail| 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
*
(Street)
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2. Issuer Name
and
Ticker or Trading Symbol
HNI CORP [ HNI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 09/01/2015 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check
Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 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 | 09/01/2015 | A | 170.197 | A | $ 0 (1) | 37,334.3138 | D | |||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 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 | ||||||||
| Explanation of Responses: |
| 1. These shares are reinvested dividends acquired by the reporting person under the Corporation's Directors Deferred Compensation Plan. |
| Julie Abramowski, By Power of Attorney | 09/02/2015 | |
| ** 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. | ||
EXHIBIT 24
LIMITED POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that I, Mary H. Bell, the undersigned, of Bradenton Beach, Manatee County, State of Florida, hereby make, constitute, and appoint Kurt A. Tjaden, Julie Abramowski and Steven M. Bradford, my true and lawful attorneys-in-fact for me and in my name, place and stead giving to such persons full power to execute and to file with the Securities and Exchange Commission ("SEC") as my attorneys-in-fact any and all SEC Forms 3, 4 or 5 required to be filed in connection with my beneficial ownership of securities of HNI Corporation (the "Corporation").
The rights, powers and authority of said attorneys-in-fact herein granted shall commence and be in full force and effect as of August 4, 2015, and such rights, powers and authority shall remain in full force and effect thereafter for so long as I am a Director of the Corporation and for such time thereafter as may be necessary to file any such reports.
IN WITNESS WHEREOF, the undersigned has executed this Limited Power of Attorney as of this 4th day of August, 2015.
/s/ Mary H. Bell
Mary H. Bell
STATE OF IOWA )
) ss.
COUNTY OF MUSCATINE )
On this 4th day of August, 2015, before me, a notary public in and for said state, personally appeared Mary H. Bell, to me personally known who, being duly sworn, acknowledged that she had executed the foregoing instrument for purposes set forth therein.
/s/ Florence E. Pedersen
Notary Public
My Commission Expires: April 4, 2017
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