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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Skogman Kyle D. 118 SECOND AVENUE SE P.O. BOX 73909 CEDAR RAPIDS, IA 52407-3909 |
X |
/s/ Kyle D. Skogman by Dianne M. Lyons, Attorney-in-Fact | 12/12/2012 | |
**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) | The total number of securities beneficially held indirectly by the reporting person following the reported transaction includes: 670 shares held in a simplified employee pension (SEP) account for Mr. Skogman's benefit; 200 shares held in an individual retirement account for Mr. Skogman's benefit; 2,000 shares held in a trust account for the benefit of Mr. Skogman's wife; 2,500 shares held in a trust account for the benefit of Mr. Skogman's wife; and 150 shares held in an individual retirement account for the benefit of Mr. Skogman's wife. |
(2) | The total number of securities beneficially held directly by the reporting person following the reported transaction includes: 11,900 shares held in a trust account for which Mr. Skogman serves as trustee; 730 shares held jointly in a brokerage account by Mr. Skogman and his wife; and 582 shares of restricted stock which vest, subject to certain conditions, on May 16, 2013. |