SEC FORM
3
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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
12/01/2021
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3. Issuer Name and Ticker or Trading Symbol
LOUISIANA-PACIFIC CORP
[ LPX ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| SVP, Manufacturing Services |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock |
203,424
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D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Stock Settled Stock Appreciation Right |
|
|
Common Stock |
9,349 |
18.09 |
D |
|
| Stock Settled Stock Appreciation Right |
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|
Common Stock |
7,500 |
17.04 |
D |
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| Stock Settled Stock Appreciation Right |
|
|
Common Stock |
10,944 |
15.74 |
D |
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| Stock Settled Stock Appreciation Right |
|
|
Common Stock |
6,493 |
19.14 |
D |
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| Explanation of Responses: |
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| Remarks: |
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/s/Nicole Daniel, Attorney-in-Fact |
12/10/2021 |
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** 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. |
| 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 Number. |
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
KNOW ALL MEN BY THESE PRESENTS, that the undersigned hereby constitutes and
appoints Nicole Daniel and Teresa Frogge, and each of them, as the true and
lawful attorney or attorneys-in-fact, with full power of substitution and
revocation, for the undersigned and in the name, place and stead of the
undersigned, in any and all capacities, to execute, on behalf of the
undersigned, (1) any and all notices pursuant to Rule l44 under the Securities
Act of 1933 with respect to sales of shares of common stock, par value $1 per
share, or other securities, of Louisiana-Pacific Corporation, including, without
limitation, all notices of proposed sale on Form 144, and (2) any and all
statements or reports under Section 16 of the Securities Exchange Act of 1934
with respect to the beneficial ownership of common stock, par value $1 per
share, or other securities, of Louisiana-Pacific Corporation, including, without
limitation, all initial statements of beneficial ownership on Form 3, all
statements of changes in beneficial ownership on Form 4, all annual statements
of beneficial ownership on Form 5 and all successor or similar forms, to be
filed with the Securities and Exchange Commission, to execute any and all
amendments or supplements to any such notices, statements or reports, and to
file the same, with all exhibits thereto, and other documents in connection
therewith, with the Securities and Exchange Commission, granting to said
attorney or attorneys-in-fact, and each of them, full power and authority to do
so and perform each and every act and thing requisite and necessary to be done
in and about the premises (including, without limitation, completing, executing,
delivering and filing a Form ID to apply for electronic filing codes), as fully
and to all intents and purposes as the undersigned might or could do in person,
and hereby ratifying and confirming all that said attorney or attorneys-in-fact,
or any of them, or their substitute or substitutes, may lawfully do or cause to
be done by virtue hereof.
The undersigned acknowledges that the foregoing attorneys-in-fact, and each of
them, in serving in such capacity at the request of the undersigned, are not
assuming any of the responsibilities of the undersigned to comply with Section
16 of the Securities Exchange Act of 1934 or any other legal requirement. This
Power of Attorney shall remain in effect until revoked in writing by the
undersigned
Date: October 22, 2021
/s/Michael W. Blosser
Name: Michael W. Blosser
