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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT 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 1474 (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 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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SUSAN L CICIORA TRUST C/O ALASKA TRUST COMPANY 1029 WEST 3RD AVENUE, SUITE 400 ANCHORAGE, AK 99501 |
X | |||
HOREJSI STEWART R 2121 E. CRAWFORD PLACE SALINA, KS 67401 |
X |
/s/ Douglas J. Blattmachr, President, Alaska Trust Company, trustee of the Susan L. Ciciora Trust | 12/23/2015 | |
**Signature of Reporting Person | Date | |
/s/ Stewart R. Horejsi | 12/23/2015 | |
**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) | The shares reported in Item 4 were acquired as a result of the dissolution and distribution of assets of Evergreen Atlantic, LLC ("EALLC"). The Susan L. Ciciora Trust ("Susan Trust") and Stewart West Indies Trust (the "West Indies Trust" and, together with the Susan Trust, the "Trusts") had 45.38% and 54.62% sharing percentages, respectively, in EALLC. Prior to distributing the Issuer's shares, EALLC held 1,072,902 shares, of which 486,883 shares were distributed to the Susan Trust and 586,019 shares were distributed to the West Indies Trust. |
(2) | The trustee of each Trust is Alaska Trust Company ("Alaska Trust"), which may be deemed to control each Trust. As a result of his advisory role with the Trusts, Stewart R. Horejsi may be deemed to have indirect beneficial ownership of the shares directly beneficially owned by the Trusts. However, Mr. Horejsi disclaims such beneficial ownership of the shares directly beneficially held by each Trust. |
(3) | The Trusts and other trusts, persons and entities affiliated with the Reporting Persons, including Lola Brown Trust No. 1B, Ernest Horejsi Trust No. 1B, Mildred B. Horejsi Trust, Stewart R. Horejsi Trust No. 2, Susan L. Ciciora and Ellen O. Horejsi (formerly Ellen O. Cooper) own an aggregate of 45,444,843 shares or approximately 42.83% of the Issuer. |