Statement of Changes in Beneficial Ownership (4)
June 06 2018 - 12:50PM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
APPLEBEE ANDREW F
|
2. Issuer Name
and
Ticker or Trading Symbol
Jacksonville Bancorp, Inc.
[
JXSB
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
CHAIRMAN OF THE BOARD
|
(Last)
(First)
(Middle)
C/O JACKSONVILLE BANCORP, INC., 1211 W. MORTON AVE.
|
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/4/2018
|
(Street)
JACKSONVILLE, IL 62650
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. 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
|
12/31/2017
|
|
A
|
|
110.9793
|
A
|
$32.02
|
4092
|
I
|
By ESOP
|
Common Stock
|
2/21/2018
|
|
G
|
|
2970
|
D
|
(1)
|
21231
|
I
|
By Spouse Trust
|
Common Stock
|
2/21/2018
|
|
G
|
|
2225
|
D
|
(2)
|
19006
|
I
|
By Spouse Trust
|
Common Stock
|
5/18/2018
|
|
G
|
|
2006
|
D
|
(1)
|
17000
|
I
|
By Spouse Trust
|
Common Stock
|
5/21/2018
|
|
G
|
|
4500
|
D
|
(1)
|
12500
|
I
|
By Spouse Trust
|
Common Stock
|
2/21/2018
|
|
G
|
|
2225
|
A
|
(3)
|
2225
|
I
|
As Custodian for grandchildren
|
Common Stock
|
4/17/2018
|
|
G
|
|
2075
|
A
|
(4)
|
4300
|
I
|
As Custodian for Grandchildren
|
cCommon Stock
|
2/21/2018
|
|
G
|
|
2970
|
A
|
(5)
|
7470
|
D
|
|
cCommon Stock
|
4/17/2018
|
|
G
|
|
2075
|
D
|
(6)
|
5395
|
D
|
|
cCommon Stock
|
5/18/2018
|
|
G
|
|
2006
|
A
|
(5)
|
7401
|
D
|
|
cCommon Stock
|
5/18/2018
|
|
G
|
|
150
|
D
|
(7)
|
7251
|
D
|
|
cCommon Stock
|
5/21/2018
|
|
G
|
|
4500
|
A
|
(5)
|
11751
|
D
|
|
cCommon Stock
|
5/22/2018
|
|
G
|
|
3000
|
D
|
(7)
|
8751
|
D
|
|
cCommon Stock
|
6/4/2018
|
|
D
|
|
8751
|
D
|
(8)
|
0
|
D
|
|
Common Stock
|
6/4/2018
|
|
D
|
|
25959
|
D
|
(8)
|
0
|
I
|
By 401k
|
Common Stock
|
6/4/2018
|
|
D
|
|
4092
|
D
|
(8)
|
0
|
I
|
By ESOP
|
Common Stock
|
6/4/2018
|
|
D
|
|
9014
|
D
|
(8)
|
0
|
I
|
By IRA
|
Common Stock
|
6/4/2018
|
|
D
|
|
10572
|
D
|
(8)
|
0
|
I
|
By Trust
|
Common Stock
|
6/4/2018
|
|
D
|
|
12500
|
D
|
(8)
|
0
|
I
|
By Spouse Trust
|
Common Stock
|
6/4/2018
|
|
D
|
|
4300
|
D
|
(8)
|
0
|
I
|
As Custodian for Grandchildren
|
Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security
(Instr. 3)
|
2. Conversion or Exercise Price of Derivative Security
|
3. Trans. Date
|
3A. Deemed Execution Date, if any
|
4. Trans. 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
|
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 of Derivative Security: 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
|
Stock Option
|
$15.65
|
6/4/2018
|
|
D
|
|
|
3000
|
4/24/2013
|
4/24/2022
|
Common Stock
|
0
|
(9)
|
0
|
D
|
|
Explanation of Responses:
|
(1)
|
Gift of shares from spouse trust to jointly held account
|
(2)
|
Gift of 445 shares to each of 5 grandchildren for a total gift of 2225.
|
(3)
|
Received 445 shares for each of 5 minor grandchildren, for a total of 2,225 shares and holds these shares as Custodian.
|
(4)
|
Received 415 shares for each of 5 minor grandchildren, for a total of 2,075 shares and holds these shares as Custodian.
|
(5)
|
Gift from spouse trust
|
(6)
|
Gift of 415 shares to each of 5 grandchildren for a total of 2,075 shares.
|
(7)
|
Gift to Schwab Charitable Trust
|
(8)
|
Each share of common stock was converted into and became exchangeable for the right to receive $33.70 in cash pursuant to an agreement and plan of merger between the Jacksonville Bancorp, Inc., CNB Bank Shares, Inc. and CNB Acquisition, Inc.
|
(9)
|
The stock option was cancelled in connection with the merger and the holder received a cash payment upon such cancellation in an amount equal to $54,150, which is equal to the product of (i) the number of shares of Issuer common stock provided for by such option and (ii) $33.70 minus $15.65, the exercise price of the option.
|
Reporting Owners
|
Reporting Owner Name / Address
|
Relationships
|
Director
|
10% Owner
|
Officer
|
Other
|
APPLEBEE ANDREW F
C/O JACKSONVILLE BANCORP, INC.
1211 W. MORTON AVE.
JACKSONVILLE, IL 62650
|
X
|
|
CHAIRMAN OF THE BOARD
|
|
Signatures
|
/s/ Andrew F. Applebee
|
|
6/5/2018
|
**
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.
|
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.
|
Jacksonville Bancorp (NASDAQ:JXSB)
Historical Stock Chart
From Oct 2024 to Nov 2024
Jacksonville Bancorp (NASDAQ:JXSB)
Historical Stock Chart
From Nov 2023 to Nov 2024