SEC Form 4 · accession 0001667682-16-000003
Embassy Bancorp, Inc. · EMYB
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Patti Gates Smith
Director
Period of report
Mar 21, 2016
Accepted (ET)
Mar 25, 2016 · 10:53 am EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001449794
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Mar 21, 2016 | J | 9,566 | $0.00 | D | 3,860 | I | Footnote |
| Common StockF2 | Mar 23, 2016 | J | 353 | $0.00 | D | 3,154 | I | Footnote |
| Common StockF3 | holding | — | — | — | 236,289 | I | Footnote | |
| Common Stock | holding | — | — | — | 3,067 | I | By IRA |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The reporting person is co-trustee of the Elmer D. Gates Revocable Trust, of which she is a co-beneficiary. On March 21, 2016, the reporting person caused the trust to distribute 19,131 shares of Embassy Bancorp, Inc. common stock to beneficiaries of the trust, including 9,565 shares to the Patti G. Smith Living Trust, of which the reporting person is the trustee and beneficiary.
- F2The reporting person is co-trustee of the Elmer D. Gates Revocable Trust, of which she is a co-beneficiary. On March 23, 2016, the reporting person caused the trust to distribute 706 shares of Embassy Bancorp, Inc. common stock to beneficiaries of the trust, including 353 shares to the Patti G. Smith Living Trust, of which the reporting person is the trustee and beneficiary.
- F3By self as trustee of the Patti G. Smith Living Trust, which reflects shares acquired in the distributions described in Footnotes 1 and 2.