0001225208-24-003519.txt : 20240304 0001225208-24-003519.hdr.sgml : 20240304 20240304203115 ACCESSION NUMBER: 0001225208-24-003519 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240301 FILED AS OF DATE: 20240304 DATE AS OF CHANGE: 20240304 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MITAU LEE R CENTRAL INDEX KEY: 0001185489 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09225 FILM NUMBER: 24717846 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] ORGANIZATION NAME: 08 Industrial Applications and Services IRS NUMBER: 410268370 STATE OF INCORPORATION: MN FISCAL YEAR END: 1202 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 X0508 4 2024-03-01 0000039368 FULLER H B CO FUL 0001185489 MITAU LEE R 1200 WILLOW LAKE BOULEVARD P.O. BOX 64683 ST. PAUL MN 55164-0683 1 0 Common Stock 42671.0000 I By Trust Stock Units 0.0000 2024-03-01 4 A 0 743.4300 79.5300 A Common Stock 743.4300 153228.6200 D Stock Units 0.0000 1988-08-08 Common Stock 50141.9500 50141.9500 D On October 20, 2021 and October 27, 2021, the reporting person withdrew a total of 34,949 shares of H.B. Fuller common stock from a grantor retained annuity trust established for the benefit of himself, his adult children and their descendants. In exchange for the shares, the reporting person contributed to the trust bonds and cash in the principal amount of $2,391,161.39. The reporting person believes that his withdrawal of shares from the trust, and their subsequent contribution into an existing revocable trust, constitute a change in form of beneficial ownership of the shares, exempted by Rule 16a-13 under the Securities Exchange Act of 1934. 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. /s/ Debra L. Hovland, Attorney-in-Fact 2024-03-04