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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | 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. | SEC 2270 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HEAD ROBERT L JR PO BOX 147 BLAIRSVILLE, GA 30514 |
 X |  |  |  |
Lois J. Rich by POA | 03/10/2010 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Reflects a gift made by Mr. Head to First United Methodist Church which was inadvertently not previously reported. |
(2) | Adjusted for 130/131 stock splits which occurred in January, April, July, and October 2009. |
(3) | Reflects a reclassification of 55,596 shares from the Indirect ownership of Mr. Head's spouse to his Direct ownership which occurred throughout 2009; a reclassification of 300,974 shares from Direct ownership to the Indirect ownership of Robert L. Head, Jr. Charitable Remainder Trust for which Mr. Head claims beneficial ownership; and a 28 share reduction caused by rounding differences pursuant to stock dividends. |
(4) | Reflects a sale of shares within the Robert L. Head, Jr. Charitable Remainder Trust to fund required distributions according to the terms of the irrevocable trust which were inadvertently not previously reported. |
(5) | Reflects a reclassification of 300,974 shares from Direct ownership to the Indirect ownership of Robert L. Head, Jr. Charitable Remainder Trust for which Mr. Head claims beneficial ownership, less the subsequent and reported sale of 144 shares. |
(6) | Adjusted for 130/131 stock split which occurred in April, July, and October 2009. |
(7) | Includes 5,697 shares owned by Mr. Head's spouse for which he claims beneficial ownership. Also reflects a reclassification of 55,596 shares to Mr. Head's Direct ownership which occurred throughout 2009. |
(8) | Includes 36,699 shares owned by Mr. Head's grandchildren for which he is custodian. |