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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 | ||||||||
2016 Performance Based Restricted Stock (3-year performance) | (5) | (6) | (6) | Common Stock | 758 | 0 | D | ||||||||
2017 Performance Based Restricted Stock (1-year performance) | (5) | (7) | (7) | Common Stock | 1,133 | $ 0 | D | ||||||||
2017 Performance Based Restricted Stock (3-year performance) | (5) | (8) | (8) | Common Stock | 566 | $ 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HORSTMANN DOUGLAS J 1398 CENTRAL AVE. DUBUQUE, IA 52001 |
EVP, Lending |
/s/ Douglas J. Horstmann | 11/17/2017 | |
**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) | These shares are held by Doulgas J Horstmann Trust under agreement dated 8/13/2011 FBO Douglas J Horstmann Declaration of Trust |
(2) | These shares are held by Douglas J Horstmann Declaration of Trust under agreement dated 8/13/2011, Douglas J Horstmann, Trustee |
(3) | These shares are held by Karen M Horstmann Declaration of Trust dated 8/13/2011, Karen M Horstmann, Trustee |
(4) | Based on a plan statement dated August 2016 |
(5) | Each restricted stock unit represents a contingent right to receive one share of Issuer's common stock. |
(6) | These restricted stock units vest in 2019 if certain performance measures are achieved by the Issuer. |
(7) | These restricted stock units vest on 1-19-2020 if certain performance measures are achieved by the Issuer. |
(8) | These restricted stock units vest in 2020 if certain performance measures are achieved by the Issuer. |