Initial Statement of Beneficial Ownership (3)
January 10 2019 - 1:20PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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Dorton Brett
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2. Date of Event Requiring Statement (MM/DD/YYYY)
1/4/2019
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3. Issuer Name
and
Ticker or Trading Symbol
SOUTHERN MISSOURI BANCORP, INC. [SMBC]
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(Last)
(First)
(Middle)
S/O SOUTHERN MISSOURI BANCORP, INC., 2991 OAK GROVE ROAD
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
EVP, Chief Strategies Officer /
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(Street)
POPLAR BLUFF, MO 63901
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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130
(1)
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D
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Common Stock
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600
(2)
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D
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Common Stock
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2489.23
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I
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Held in 401(k)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (Right to Buy)
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(3)
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1/4/2029
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Common Stock
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2000
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$34.35
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D
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Explanation of Responses:
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(1)
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Shares were converted from Gideon Bancshares Company shares to Southern Missouri Bancorp, Inc. shares at the closing of the merger.
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(2)
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The shares are scheduled to vest over a five-year period beginning February 9, 2020, with up to 20% of the shares vesting on that date and on each of the next four anniversaries of that date based on the extent to which the Company's annualized return on average assets over the 12 calendar quarters ending immediately prior to the applicable vesting date exceeds a threshold level.
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(3)
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The options become exercisable in 20% installments over a five year period with the first installment vesting on 1/4/2020. Each remaining installment vests annually thereafter.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Dorton Brett
S/O SOUTHERN MISSOURI BANCORP, INC.
2991 OAK GROVE ROAD
POPLAR BLUFF, MO 63901
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EVP, Chief Strategies Officer
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Signatures
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/s/ Brett Dorton
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1/10/2019
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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