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*
McKeown Ann Marie

(Last) (First) (Middle)
20 CUSTOM HOUSE ST

(Street)
BOSTON MA 02110

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
SAFETY INSURANCE GROUP INC [ SAFT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
V.P Insurance Operations
3. Date of Earliest Transaction (Month/Day/Year)
02/24/2021
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 02/24/2021 A 1,703 A $0(1) 23,172 D
Common Stock 02/24/2021 A 2,104 A $0(2) 25,276 D
Common Stock 02/24/2021 J 1,600(3) A $0 26,876 D
Common Stock 02/26/2021 F 1,071(4) D $79.648(5) 25,805 D
Common Stock 02/26/2021 F 200(4) D $80.61(6) 25,605 D
Common Stock 02/26/2021 F 400(4) D $81.3(7) 25,205 D
Common Stock 03/01/2021 F 723(4) D $80.739(8) 24,482 D
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
Explanation of Responses:
1. Represents restricted stock awards effective February 24, 2021, with respect to which sale or transfer rights shall vest over three years with installments of 30% on February 24, 2022, 30% on February 24, 2023, and the remaining 40% on February 24, 2024, provided the grantee meets certain employment conditions.
2. Represents restricted stock awards granted effective February 24, 2021 with respect to which sale or transfer rights will vest over a three-year performance period commencing on January 1, 2021 and ending on December 31, 2023. Vesting of these shares is dependent upon the attainment of pre-established performance objectives, and any difference between shares granted and shares earned at the end of the performance period will be reported at the conclusion of the performance period in 2024.
3. Represents the difference between performance shares, with a three year performance period, that were granted on February 26, 2018 and actual shares earned at the end of the performance period on December 31, 2020. Final shares were approved by the Compensation Committee on February 24, 2021.
4. Represents securities delivered in payment of a tax liability with respect to vesting of securities issued in accordance with Rule 16b-3.
5. Represents the weighted average sale price of multiple open market same day sales with prices ranging from $79.14 to $80.00 per share. Full information regarding the number of shares sold at each separate price will be provided to the Securities and Exchange Commission or a security holder of the issuer upon request.
6. Represents the weighted average sale price of multiple open market same day sales with prices ranging from $80.16 to $81.06 per share. Full information regarding the number of shares sold at each separate price will be provided to the Securities and Exchange Commission or a security holder of the issuer upon request.
7. Represents the weighted average sale price of multiple open market same day sales with prices ranging from $81.21 to $81.34 per share. Full information regarding the number of shares sold at each separate price will be provided to the Securities and Exchange Commission or a security holder of the issuer upon request.
8. Represents the weighted average sale price of multiple open market same day sales with prices ranging from $80.27 to $81.12 per share. Full information regarding the number of shares sold at each separate price will be provided to the Securities and Exchange Commission or a security holder of the issuer upon request.
/s/Ann M. McKeown 03/02/2021
** 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.
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