SEC Form 4 · accession 0001415889-18-000874

Jacksonville Bancorp, Inc. · JXSB

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — CHAIRMAN OF THE BOARD · Director

Period of report

Jun 4, 2018

Accepted (ET)

Jun 6, 2018 · 12:48 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001484949

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock	Dec 31, 2017	A	111	$32.02	A	4,092	I	By ESOP
Common Stock^F1	Feb 21, 2018	G	2,970	—	D	21,231	I	By Spouse Trust
Common Stock^F2	Feb 21, 2018	G	2,225	—	D	19,006	I	By Spouse Trust
Common Stock^F1	May 18, 2018	G	2,006	—	D	17,000	I	By Spouse Trust
Common Stock^F1	May 21, 2018	G	4,500	—	D	12,500	I	By Spouse Trust
Common Stock^F3	Feb 21, 2018	G	2,225	—	A	2,225	I	As Custodian for grandchildren
Common Stock^F4	Apr 17, 2018	G	2,075	—	A	4,300	I	As Custodian for Grandchildren
cCommon Stock^F5	Feb 21, 2018	G	2,970	—	A	7,470	D
cCommon Stock^F6	Apr 17, 2018	G	2,075	—	D	5,395	D
cCommon Stock^F5	May 18, 2018	G	2,006	—	A	7,401	D
cCommon Stock^F7	May 18, 2018	G	150	—	D	7,251	D
cCommon Stock^F5	May 21, 2018	G	4,500	—	A	11,751	D
cCommon Stock^F7	May 22, 2018	G	3,000	—	D	8,751	D
cCommon Stock^F8	Jun 4, 2018	D	8,751	—	D	0	D
Common Stock^F8	Jun 4, 2018	D	25,959	—	D	0	I	By 401k
Common Stock^F8	Jun 4, 2018	D	4,092	—	D	0	I	By ESOP
Common Stock^F8	Jun 4, 2018	D	9,014	—	D	0	I	By IRA
Common Stock^F8	Jun 4, 2018	D	10,572	—	D	0	I	By Trust
Common Stock^F8	Jun 4, 2018	D	12,500	—	D	0	I	By Spouse Trust
Common Stock^F8	Jun 4, 2018	D	4,300	—	D	0	I	As Custodian for Grandchildren

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Stock Option^F9	$15.65	Jun 4, 2018	D	3,000	D	Apr 24, 2013	Apr 24, 2022	Common Stock	0	0	D

F1Gift of shares from spouse trust to jointly held account
F2Gift of 445 shares to each of 5 grandchildren for a total gift of 2225.
F3Received 445 shares for each of 5 minor grandchildren, for a total of 2,225 shares and holds these shares as Custodian.
F4Received 415 shares for each of 5 minor grandchildren, for a total of 2,075 shares and holds these shares as Custodian.
F5Gift from spouse trust
F6Gift of 415 shares to each of 5 grandchildren for a total of 2,075 shares.
F7Gift to Schwab Charitable Trust
F8Each share of common stock was converted into and became exchangeable for the right to receive $33.70 in cash pursuant to an agreement and plan of merger between the Jacksonville Bancorp, Inc., CNB Bank Shares, Inc. and CNB Acquisition, Inc.
F9The stock option was cancelled in connection with the merger and the holder received a cash payment upon such cancellation in an amount equal to $54,150, which is equal to the product of (i) the number of shares of Issuer common stock provided for by such option and (ii) $33.70 minus $15.65, the exercise price of the option.