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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Call Option (obligation to sell) | $ 10 | 08/27/2012 | X | 100,000 | 08/27/2009 | 08/27/2012 | Common Stock | 100,000 | $ 0 | 0 | I | See footnote 1 | |||
Call Option (obligation to sell) | $ 10 | 08/27/2012 | X | 100,000 | 08/27/2009 | 08/27/2012 | Common Stock | 100,000 | $ 0 | 0 | I | See footnote 2 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
CORRELL JESSE T FIRST SOUTHERN BANCORP P. O. BOX 328 STANFORD, KY 40484 |
X | X | Chairman & CEO |
/s/ Jill Martin, Attorney-in-Fact | 08/29/2012 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | By First Southern Bancorp, Inc. (FSB) of which the reporting person is Chairman and President. On August 27, 2009, FSB and First Southern Holdings, LLC (FSH), individually and collectively, granted call options under which a total of 200,000 shares of the Issuer's common stock could be purchased. Under the terms of the options, FSB and FSH, in their sole discretion, could determine the number of shares each of them would sell to the exercising optionee. On August 26, 2011, the holders of the options exercised the options with respect to a total of 100,000 shares of the Issuer's common stock. On August 27, 2012, the holders of the options exercised the remaining options with respect to a total of 100,000 shares of the Isuer's common stock which consisted of 75,840 shares from FSH and 24,160 shares from FSB. |
(2) | By FSH of which the reporting person is the President. On August 27, 2009, FSB and FSH, individually and collectively, granted call options under which a total of 200,000 shares of the Issuer's common stock could be purchased. Under the terms of the options, FSB and FSH, in their sole discretion, could determine the number of shares each of them could sell to the exercising optionee. On August 26, 2011, the holders of the options exercised the options with respect to a total of 100,000 shares of the Issuer's common stock. On August 27, 2012, the holders of the options exercised the remaining options with respect to a total of 100,000 shares of the Issuer's common stock which consisted of 75,840 shares from FSH and 24,160 from FSB. |
(3) | Received in payment of previously contracted debt. The reporting person disclaims beneficial ownership of the securities held by Bluegrass Farms & Woodlands, LLC except to the extent of his pecuniary interest therein. |