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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 | |
McIntyre Dee Ann 2007 FIRST AVENUE SE CEDAR RAPIDS, IA 52406-2804 |
 |  X |  |  |
Dee Ann McIntyre, by Mark R. Van Heukelom, Attorney-in-Fact | 02/14/2017 | |
**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 number of securities directly owned by the Reporting Person at the end of the issuer's fiscal year includes: 168 certificated shares, 16,500 shares in an individual retirement account, and 30,966 shares held in a revocable trust for the Reporting Person's benefit (of which 10,966 shares are held in one revocable trust account, and 20,000 shares are held in an another revocable trust account). Form 4s for the transactions dated 12/16/2016 and 12/19/2016 were not filed at the time of the transactions, but have been filed prior to the filing of this Form 5. |
(2) | The Reporting Person is a lifetime beneficiary of the Dee Ann McIntyre Irrevocable Trust. |
(3) | The McIntyre Foundation is a private foundation, for which the Reporting Person serves as one of three directors. |
(4) | The Reporting Person hereby expressly declares that, pursuant to 17 CFR 240.13d-4, this filing shall not be construed as an admission that such person is a beneficial owner of any securities covered by this statement. |