SEC FORM
4
SEC Form 4
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
SECURITY NATIONAL FINANCIAL CORP
[ SNFCA ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
X |
10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Chairman, CEO |
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3. Date of Earliest Transaction
(Month/Day/Year) 08/23/2004
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Class A Common Stock |
08/23/2004 |
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P |
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350 |
A |
$3.35
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554,725 |
D |
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Class A Common Stock |
12/23/2004 |
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M |
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42,444 |
A |
$4.69
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597,169 |
D |
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Class A Common Stock |
12/23/2004 |
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M |
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25,854 |
A |
$6.49
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623,023 |
D |
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Class A Common Stock |
01/22/2005 |
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J
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31,494 |
A |
$0
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661,374
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D |
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class A Common Stock |
01/22/2005 |
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J
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159,937 |
A |
$0
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3,358,687
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D |
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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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 |
Employee Stock Option (right to buy) |
$2.64
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11/29/2001 |
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A |
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40,000 |
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11/29/2003 |
11/29/2008 |
Class A Common Stock |
40,000 |
$0
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40,000
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D |
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Employee Stock Option (right to buy) |
$3.96
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07/16/2004 |
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A |
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50,000 |
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07/16/2004 |
07/16/2009 |
Class A Common Stock |
50,000 |
$0
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50,000
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D |
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Employee Stock Option (right to buy) |
$3.55
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12/10/2004 |
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A |
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50,000 |
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12/10/2004 |
12/10/2009 |
Class A Common Stock |
50,000 |
$0
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50,000
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D |
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Employee Stock Option (right to buy) |
$4.69
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12/23/2004 |
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M |
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42,444 |
11/27/2002 |
11/27/2007 |
Class A Common Stock |
42,444 |
$0
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0 |
D |
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Employee Stock Option (right to buy) |
$6.49
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12/23/2004 |
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M |
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25,854 |
03/21/2003 |
03/21/2008 |
Class A Common Stock |
25,854 |
$0
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0 |
D |
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Explanation of Responses: |
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/s/George R. Quist |
03/31/2005 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* 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). |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
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 Number. |
EXHIBIT 99
George R. Quist
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1/ Received pursuant to a 5% stock dividend paid on January 22, 2005.
2/ Includes 426,375 shares of Class A Common Stock and 3,358,687 shares of
Class C Common Stock owned by the George R. and Shirley C. Quist Family
Partnership, Ltd., 61,325 shares of Class A Common Stock and 470,581
shares of Class C Common Stock owned indirectly by the reporting
person, including (A) 19,239 shares of Class A Common Stock and 211,358
shares of Class C Common Stock held by Associated Investors and
allocated to the reporting person's partner's account (including 916
shares of Class A Common Stock and 10,065 shares of Class C Common
Stock that were allocated to the reporting person's partner's account
on January 22, 2005 pursuant to a 5% stock dividend declared on
December 10, 2004), of which the reporting person disclaims voting and
investment powers with respect to such shares; (B) 6,177 shares of
Class A Common Stock acquired pursuant to the Security National
Financial Corporation Tax-Favored Retirement Savings Plan (401(k) Plan)
and allocated to the reporting person's account (including 34 shares of
Class A Common Stock the reporting person acquired and 1,050 shares of
Class A Common Stock the reporting person disposed of under the 401(k)
Plan between April 1, 2004 and December 31, 2004, and 294 shares of
Class A Common Stock that were allocated to the reporting person's
account on January 22, 2005 pursuant to a 5% stock dividend declared on
December 10, 2004), of which the reporting person disclaims voting
powers and investment with respect to such shares; (C) 8,476 shares of
Class A Common Stock and 259,223 shares of Class C Common Stock
acquired under the Security National Financial Corporation Employee
Stock Ownerships Plan (ESOP), in reliance on old Rule 16a-8(g)(3)
(including 5,808 shares of Class A Common Stock the reporting person
disposed of under the ESOP Plan between April 1, 2004 and December 31,
2004, and 404 shares of Class A Common Stock and 121,344 shares of
Class C Common Stock that were allocated to the reporting person's
account on January 22, 2005 pursuant to a 5% stock dividend declared on
December 10, 2004), of which the reporting person disclaims voting and
investment powers with respect to such shares; and (D) 27,433 shares of
Class A Common Stock acquired under the Security National Financial
Corporation Deferred Compensation Plan (including 6,080 shares of Class
A Common Stock the reporting person acquired under the Deferred
Compensation Plan between April 1, 2004 and December 31, 2004, and
1,306 shares of Class A Common Stock that were allocated to the
reporting person's account on January 22, 2005 pursuant to a 5% stock
dividend on December 10, 2004), of which the reporting person disclaims
voting and investment powers with respect to such shares. The reporting
person disclaims beneficial ownership of the reported securities except
to the extent of his pecuniary interest therein.
3/ Grant to reporting person of options to purchase 40,000 shares of Class
A Common Stock under the Security National Financial Corporation 1993
Stock Option Plan. The options became exercisable on November 29, 2003.
4/ Grant to reporting person of options to purchase 50,000 shares of Class
A Common Stock under the Security National Financial Corporation 2003
Stock Option Plan. The options became exerciseable on July 16, 2004.
5/ Grant to reporting person of options to purchase 50,000 shares of Class
A Common Stock under the Security National Financial Corporation 2003
Stock Option Plan. The options became exerciseable on December 10,
2004.