Upgrade to SI Premium - Free Trial

Form 3 HNI CORP For: Nov 07 Filed by: Sieben Brandon T

November 9, 2018 11:16 AM
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0104
Expires: December 31, 2014
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person *
Sieben Brandon T

(Last) (First) (Middle)
600 EAST SECOND STREET

(Street)
MUSCATINE IA 52761

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/07/2018
3. Issuer Name and Ticker or Trading Symbol
HNI CORP [ HNI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President, Allsteel Inc.
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 19,884.084
D
Common Stock 2,594.0601
I
Profit Sharing Retirement Plan
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Non-qualifying employee stock option (right to buy) 02/13/2017 (1) 02/13/2023 Common Stock 5,888 31.79 D
Non-qualifying employee stock option (right to buy) 02/12/2018 (1) 02/12/2024 Common Stock 5,670 34.78 D
Non-qualifying employee stock option (right to buy) 02/18/2019 (2) 02/18/2025 Common Stock 3,664 51.54 D
Non-qualifying employee stock option (right to buy) 02/17/2020 (2) 02/17/2026 Common Stock 10,610 32.03 D
Non-qualifying employee stock option (right to buy) 02/15/2021 (2) 02/15/2027 Common Stock 6,728 46.62 D
Non-qualifying employee stock option (right to buy) 02/14/2022 (2) 02/14/2028 Common Stock 20,674 38.68 D
Restricted Stock Units 08/07/2020 (3) Common Stock 9,289 0 (4) D
Explanation of Responses:
1. The option became fully vested and exercisable in one installment on the fourth anniversary of the grant date.
2. The option will become fully vested and exercisable in one installment on the fourth anniversary of the grant date.
3. On August 7, 2018, the reporting person was granted restricted stock units, vesting in two equal installments beginning on the second anniversary of the grant date.
4. Each restricted stock unit represents a contingent right to receive one share of HNI Corporation Common Stock.
Remarks:
Exhibit List: Exhibit 24-1 Power of Attorney
/s/ Brandon T. Sieben 11/09/2018
** 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

             KNOW ALL BY THESE PRESENTS, that the undersigned hereby constitutes and appoints each of Marshall H. Bridges, Steven M. Bradford and Julie M. Abramowski, or any of them signing singly, with full power of substitution, as the undersigned's true and lawful attorney-in-fact to:

(1)    Execute for and on behalf of the undersigned, in the undersigned's capacity as an officer and/or Director of HNI Corporation (the "Company"), Forms 3, 4 and 5 (including amendments thereto) in accordance with Section 16(a) of the Securities and Exchange Act of 1934, as amended (the "Exchange Act"), and rules and regulations thereunder;
(2)    Do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Forms 3, 4 or 5, complete and execute any amendment or amendments thereto, and timely file such forms with the United States Securities and Exchange Commission ("SEC") and any stock exchange or similar authority; and
(3)    Take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by or for, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such information, disclosure and terms and conditions as such attorney-in-fact may approve in such attorney-in-fact's discretion.

             The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request and on the behalf of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with, or any liability for the failure to comply with, any provision of Section 16 of the Exchange Act.

    This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 or 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

    IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 6 day of November, 2018.

Brandon T. Sieben
/s/ Brandon T. Sieben
Signature

Categories

SEC Filings