Statement of Changes in Beneficial Ownership (4)
December 06 2021 - 1:38PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
MUELLER WAYNE D. |
2. Issuer Name and Ticker or Trading Symbol
County Bancorp, Inc.
[
ICBK
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
|
(Last)
(First)
(Middle)
2400 S. 44TH STREET |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/3/2021 |
(Street)
MANITOWOC, WI 54220
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
|
1.Title of Security (Instr. 3)
|
2. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. Code (Instr. 8)
|
4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
|
5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
|
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
|
7. Nature of Indirect Beneficial Ownership (Instr. 4)
|
Code
|
V
|
Amount
|
(A) or (D)
|
Price
|
COMMON STOCK | 12/3/2021 | | D | | 66854 | D | (1) | 0 | D | |
COMMON STOCK | 12/3/2021 | | D | | 4380 | D | (1) | 0 | I | BY SPOUSE |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security (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) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | Each share of the issuer's common stock was disposed of pursuant to the Agreement and Plan of Merger between the issuer and Nicolet Bankshares, Inc. ("Nicolet") in exchange for either 0.48 shares of Nicolet common stock or $37.18 in cash. Each share of Nicolet common stock had a closing market value of $74.19 per share on the effective date of the merger. |
Reporting Owners
|
Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
MUELLER WAYNE D. 2400 S. 44TH STREET MANITOWOC, WI 54220 | X |
|
|
|
Signatures
|
/s/ Timothy J. Schneider, POA | | 12/6/2021 |
**Signature of Reporting Person | Date |
County Bancorp (NASDAQ:ICBK)
Historical Stock Chart
From Aug 2024 to Sep 2024
County Bancorp (NASDAQ:ICBK)
Historical Stock Chart
From Sep 2023 to Sep 2024