Annual Statement of Changes in Beneficial Ownership (5)
February 14 2017 - 1:44PM
Edgar (US Regulatory)
FORM 5
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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).
[ ]
Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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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
*
Bittner Elaine B.
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2. Issuer Name
and
Ticker or Trading Symbol
CHESAPEAKE UTILITIES CORP [CPK]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Senior VP - Strategic Dev.
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(Last)
(First)
(Middle)
909 SILVER LAKE BOULEVARD
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2016
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(Street)
DOVER, DE 19904
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Common Stock
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4/5/2016
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J
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97
(1)
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A
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$60.845
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20580
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D
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Common Stock
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4/5/2016
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L
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16
(2)
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A
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$60.845
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20596
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D
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Common Stock
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5/5/2016
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L
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16
(2)
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A
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$62.905
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20612
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D
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Common Stock
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6/6/2016
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L
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17
(2)
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A
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$58.88
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20629
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D
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Common Stock
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7/5/2016
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J
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95
(1)
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A
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$66.43
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20724
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D
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Common Stock
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7/5/2016
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L
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15
(2)
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A
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$66.43
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20739
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D
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Common Stock
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8/5/2016
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L
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15
(2)
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A
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$64.17
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20754
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D
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Common Stock
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9/5/2016
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L
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16
(2)
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A
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$63.775
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20770
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D
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Common Stock
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10/5/2016
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J
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108
(1)
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A
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$58.34
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20878
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D
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Common Stock
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10/5/2016
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L
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17
(2)
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A
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$58.34
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20895
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D
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Common Stock
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11/7/2016
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L
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17
(2)
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A
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$59.075
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20912
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D
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Common Stock
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12/5/2016
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L
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16
(2)
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A
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$63.9
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20928
(3)
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D
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Common Stock
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7712
(4)
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I
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401k Plan
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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Shares were acquired for the reporting person since last filing through reinvestment of dividends under Chesapeake Utilities Corporation's Automatic Dividend Reinvestment and Direct Stock Purchase Plan.
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(
2)
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Shares acquired by the reporting person since last filing under Chesapeake Utilities Corporation's Automatic Dividend Reinvestment and direct Stock Purchase Plan.
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(
3)
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Of these shares, 1,561 represent deferred stock units that will be settled on a one-for-one basis in common stock.
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(
4)
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Includes 91 shares of common stock that the reporting person acquired under the 401(k) Plan via an employer supplemental contribution that was funded in shares of Chesapeake Utilities Corporation common stock in August of 2016. Dividends payable on 401k Plan shares were reinvested to purchase 108 additional shares of Chesapeake Utilities Corporation common stock since last filing.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Bittner Elaine B.
909 SILVER LAKE BOULEVARD
DOVER, DE 19904
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Senior VP - Strategic Dev.
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Signatures
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Beth W. Cooper, by Power of Attorney
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2/14/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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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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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 control number.
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