SEC Form 5 · accession 0000726958-17-000065
CASEYS GENERAL STORES INC · CASY
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
William J Walljasper
Officer — Senior VP and CFO
Period of report
Apr 30, 2017
Accepted (ET)
Jul 18, 2017 · 3:04 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000726958
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Dec 23, 2013 | G | 150 | $0.00 | D | 19,386 | D | |
| Common StockF1,F2 | Jul 2, 2015 | G | 200 | $0.00 | D | 19,386 | D | |
| Common StockF1,F2 | Dec 21, 2016 | G | 100 | $0.00 | D | 19,386 | D | |
| Common StockF3 | holding | — | — | — | 6,437 | I | Voting and tender rights under 401k plan |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Option - right to buyF4 | $25.26 | holding | — | — | — | Jun 23, 2012 | Jun 23, 2019 | Common Stock | 15,300 | 15,300 | D |
| Option - right to buyF5 | $44.39 | holding | — | — | — | Jun 23, 2014 | Jun 23, 2021 | Common Stock | 20,000 | 20,000 | D |
| Restricted stock unitsF6,F7 | — | holding | — | — | — | — | — | Common Stock | 3,250 | 3,250 | D |
| Restricted stock unitsF8,F7 | — | holding | — | — | — | — | — | Common Stock | 3,250 | 3,250 | D |
| Restricted stock unitsF9,F7 | — | holding | — | — | — | — | — | Common Stock | 3,250 | 3,250 | D |
Explanation of responses
- F1The number of shares reported reflects a bona fide gift of shares to a charitable organization on the transaction date that has not been previously reported by Mr. Walljasper. The omitted shares also were included in the Table I, Column 5 beneficial ownership reported in the intervening Forms 4 and 4/A filed by Mr. Walljasper between the applicable transaction date and this Form 5.
- F2Reflects the number of shares directly owned by Mr. Walljasper as of the end of Casey's fiscal year, April 30, 2017, taking into account the amendment reported on Form 4/A being filed with this Form 5.
- F3Allocated to Mr. Walljasper's 401k plan account as of the end of Casey's fiscal year, April 30, 2017. Does not include any shares allocated by the plan trustee after that date.
- F4Pursuant to terms and conditions of 2000 Stock Option Plan (or predecessor plan).
- F5Pursuant to terms and conditions of 2009 Stock Incentive Plan.
- F6Pursuant to terms and conditions of 2009 Stock Incentive Plan. As reported in the intervening Form 4 on June 6, 2017, this award vested in full on June 6, 2017; however, the holding (and the other holdings in Table II) reflects Mr. Walljasper's ownership of derivative securities as of the end of Casey's fiscal year, April 30, 2017.
- F7Each restricted stock unit represents the right to receive, following vesting, one share of Common Stock.
- F8Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 5, 2018.
- F9Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 2, 2019.