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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 | ||||||||
Option - right to buy (2) | $ 25.26 | 06/23/2012 | 06/23/2019 | Common Stock | 12,500 | 12,500 | D | ||||||||
Option - right to buy (3) | $ 44.39 | 06/23/2014 | 06/23/2021 | Common Stock | 20,000 | 20,000 | D | ||||||||
Restricted stock units (4) | (5) | (4) | (4) | Common Stock | 3,250 | 3,250 | D | ||||||||
Restricted stock units (6) | (5) | (6) | (6) | Common Stock | 3,250 | 3,250 | D | ||||||||
Restricted stock units (7) | (5) | (7) | (7) | Common Stock | 1,554 | 1,554 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Jackowski Julia L ONE SE CONVENIENCE BLVD. ANKENY, IA 50021 |
SVP, Corp Gen Counsel, Sec |
Scott Faber, under Power of Attorney dated March 3, 2017 | 12/20/2017 | |
**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) | Allocated to Ms. Jackowski's 401k plan account as of April 30, 2017. Does not include any shares allocated by the plan trustee after that date. |
(2) | Pursuant to terms and conditions of 2000 Stock Option Plan. |
(3) | Pursuant to terms and conditions of 2009 Stock Incentive Plan. |
(4) | Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 5, 2018. |
(5) | Each restricted stock unit represents the right to receive, following vesting, one share of Common Stock. |
(6) | Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 2, 2019. |
(7) | Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 15, 2020. Not included in the reported award amount is a target amount of performance-based restricted stock units that will vest on June 15, 2020, but which are subject to the satisfaction of certain performance criteria other than solely the price of Casey's Common Stock; the final amount of shares earned, if any, will be reported upon vest and satisfaction of those performance measures. |