SEC Form 4 · accession 0001415889-18-000884

Jacksonville Bancorp, Inc. · JXSB

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

Reporting owner

Officer — PRESIDENT AND CEO · Director

Period of report

Jun 4, 2018

Accepted (ET)

Jun 6, 2018 · 12:57 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	245	$32.02	A	5,074	I	By ESOP
Common Stock^F1	May 17, 2018	G	1,000	—	D	27,453	D
Common Stock^F2	May 17, 2018	G	2,600	—	D	24,853	D
Common Stock^F3	Jun 4, 2018	D	24,853	—	D	0	D
Common Stock^F3	Jun 4, 2018	D	5,074	—	D	0	I	By ESOP
Common Stock^F3	Jun 4, 2018	D	40,332	—	D	0	I	By 401k
Common Stock^F3	Jun 4, 2018	D	4,156	—	D	0	I	By IRA
Common Stock^F3	Jun 4, 2018	D	45	—	D	0	I	By Spouse

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Stock Option^F4	$15.65	Jun 4, 2018	D	7,200	D	Apr 24, 2013	Apr 24, 2022	Common Stock	7,200	0	D

F1Gift of 250 shares to each of his 4 grandchildren.
F2Gift of 2,600 shares owned jointly with spouse to Schwab Charitable.
F3Each 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.
F4The stock option was cancelled in connection with the merger and the holder received a cash payment upon such cancellation in an amount equal to $129,960.00, the product of (i) the number of shares or Issuer common stock provided for by such option and (ii) $33.70 minus $15.65, the exercise price of the option.