0001225208-21-004028.txt : 20210301 0001225208-21-004028.hdr.sgml : 20210301 20210301155746 ACCESSION NUMBER: 0001225208-21-004028 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210226 FILED AS OF DATE: 20210301 DATE AS OF CHANGE: 20210301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MITAU LEE R CENTRAL INDEX KEY: 0001185489 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09225 FILM NUMBER: 21697567 MAIL ADDRESS: STREET 1: P O BOX 1441 CITY: MINNEAPOLIS STATE: MN ZIP: 55440-1441 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FULLER H B CO CENTRAL INDEX KEY: 0000039368 STANDARD INDUSTRIAL CLASSIFICATION: ADHESIVES & SEALANTS [2891] IRS NUMBER: 410268370 STATE OF INCORPORATION: MN FISCAL YEAR END: 1128 BUSINESS ADDRESS: STREET 1: 1200 WILLOW LAKE BLVD CITY: ST PAUL STATE: MN ZIP: 55110-5132 BUSINESS PHONE: 6126453401 MAIL ADDRESS: STREET 1: 1200 WILLOW LAKE BLVD CITY: ST PAUL STATE: MN ZIP: 55110-5132 4 1 doc4.xml X0306 4 2021-02-26 0000039368 FULLER H B CO FUL 0001185489 MITAU LEE R 1200 WILLOW LAKE BOULEVARD P.O. BOX 64683 ST. PAUL MN 55164-0683 1 Common Stock 42671.0000 I By GRAT Stock Units 0.0000 2021-02-26 4 A 0 843.5900 56.0700 A Common Stock 843.5900 132202.0700 D Stock Units 0.0000 1988-08-08 Common Stock 48547.0500 48547.0500 D These shares have been held in a series of grantor retained annuity trusts since January 24, 2020. These units convert into shares of common stock on a 1-for-1 basis. These units will be converted into shares of common stock upon retirement, death, disability or certain specified events, all as defined in such plan, subject to holding periods required by law. This amount includes stock units acquired pursuant to a dividend equivalent feature of the Directors' Deferred Compensation Plan. These units (acquired before 12-31-04) will be converted into shares of common stock upon retirement, death, disability or certain specified events, all as defined in such plan, subject to holding periods required by law. The reporting person no longer has a reportable beneficial ownership in 100 shares of common stock owned by his daughter and included in the reporting person's prior ownership reports. /s/ Timothy J. Keenan, Attorney-in-Fact 2021-03-01