SEC Form 3
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
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1. Name and Address of Reporting Person*
Hagedorn Jason Dean

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

(Street)
MUSCATINE IA 52761

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/01/2020
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 3,174.18 D
Common Stock 583.514 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 options (right to buy) 02/18/2019(1) 02/18/2025 Common Stock 676 51.54 D
Non-qualifying employee stock options (right to buy) 02/17/2020(1) 02/17/2026 Common Stock 1,769 32.03 D
Non-qualifying employee stock options (right to buy) 02/15/2021(2) 02/15/2027 Common Stock 2,227 46.62 D
Non-qualifying employee stock options (right to buy) 02/15/2020(3) 02/15/2027 Common Stock 7,500 46.62 D
Non-qualifying employee stock options (right to buy) 02/14/2022(2) 02/14/2028 Common Stock 4,877 38.68 D
Non-qualifying employee stock options (right to buy) 02/13/2023(2) 02/13/2029 Common Stock 12,175 39.77 D
Performance Standard Units 12/31/2022 (4) Common Stock 2,590 0.0 D
Restricted Stock Units 08/07/2018 (5) Common Stock 2,322 0.0 D
Restricted Stock Units 02/12/2020 (6) Common Stock 2,590 0.0 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. The option became fully vested and exercisable in one installment on the third anniversary of the grant date.
4. On February 12, 2020, the reporting person was granted performance standard units to become fully vested on December 31, 2022. These shares will not be distributed until after HNI Corporation's February 2023 Board Meeting and only upon achievement of performance goals.
5. On August 7, 2018, the reporting person was granted restricted stock units, vesting in two equal installments beginning on the first anniversary of the grant date. The first installment of 2,323 units fully vested on August 7, 2020. The second installment of 2,322 units will vest on August 7, 2021.
6. On February 12, 2020, the reporting person was granted restricted stock units, vesting one-third per year in equal installments beginning on the first anniversary of the grant date.
Remarks:
Exhibit List: Exhibit 24-1 Power of Attorney
/s/ Jason D. Hagedorn 12/11/2020
** 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 5 (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.
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