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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 at End of Issuer's Fiscal Year (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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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Stock Option | $ 74.96 | Â | Â | Â | Â | Â | 12/07/2007 | 12/07/2012 | Common Stock | Â | 400 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Burt Brady T 50 N. THIRD STREET NEWARK, OH 43055 |
 |  |  Chief Accounting Officer |  |
David L. Trautman, by Power of Attorney for Brady T. Burt | 02/01/2011 | |
**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) | Between 1/1/10 and 12/31/10, the Reporting Person acquired 391.336 common shares under the Park National Corp. Employees Stock Ownership Plan (the "KSOP") through Section 401(k) Contributions and Employer Matching Contributions. Between 8/23/07 and 12/31/07 the reporting person acquired 764.72 common shares under the KSOP, reflecting Rollover Contributions, which were reported in the Form 5 filing for year end 12/31/07. No Form 5 was filed for year end 12/31/08 as there were no other transactions for the year. The Form 5 filed for year end 12/31/09 inadvertently omitted the shares from the previous rollover and the reduction in common shares held under the KSOP as a result of the partial refund required to satisfy compliance tests applicable to the KSOP. This amendment of the Form 5 filed 1/4/11 corrects these errors. |