UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Fulp Robert C 3551 SEVENTH STREET SUITE 204 MOLINE, IL 61265 |
 |  |  Chief Exec Officer, SFC Bank |  |
By: Shellee R Showalter For: Robert C Fulp | 07/10/2018 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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) | Pursuant to the Agreement and Plan of Merger, dated as of April 17, 2018 (the "Merger Agreement"), each share of Springfield Bancshares, Inc. ("Springfield") stock held by the reporting person was converted into and became exchangeable for shares of QCR Holdings, Inc. common stock. Under the terms of the Merger Agreement, for each share of Springfield common stock, the reporting person will receive $1.50 in cash and 0.3060 shares of QCR Holdings, Inc. common stock, par value $1.00 per share, and cash in lieu of fractional shares. Set forth above is the number of shares of QCR Holdings, Inc. stock beneficially owned by the reporting person based upon the conversion procedures set forth in the Merger Agreement. |