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)
| SALT LAKE CITY |
UT |
84157-0220 |
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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)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| First V.P., Secretary |
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3. Date of Earliest Transaction
(Month/Day/Year)
01/22/2005
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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 |
01/22/2005 |
|
J
|
|
1,227 |
A |
$0
|
25,760
|
D |
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| Class C Common Stock |
01/22/2005 |
|
J
|
|
2,855 |
A |
$0
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59,954
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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) |
$5.9
|
03/21/2003 |
|
A |
|
35,000 |
|
03/21/2003 |
03/21/2013 |
Class A Common Stock |
35,000 |
$0
|
35,000
|
D |
|
| Employee Stock Option (right to buy) |
$3.23
|
12/10/2004 |
|
A |
|
10,000 |
|
12/10/2004 |
12/10/2014 |
Class A Common Stock |
10,000 |
$0
|
10,000
|
D |
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| Explanation of Responses: |
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|
/s/G. Robert 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
G. Robert Quist
---------------
1/ Received pursuant to a 5% stock dividend paid on January 22, 2005.
2/ Includes 5,735 shares of Class A Common Stock and 22,924 shares of
Class C Common Stock owned jointly by the reporting person and his
former wife, Beth Quist, including 273 shares of Class A Common Stock
and 1,092 shares of Class C Common Stock that were allocated on January
22, 2005 pursuant to a stock dividend declared on December 10, 2004.
Does not include 37,452 shares of Class A Common Stock and 184,098
shares of Class C Common Stock owned indirectly by the reporting
person, including (A) 10,039 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 695 shares of Class A Common Stock the
reporting person acquired under the 401(k) Plan between April 1, 2004
and December 31, 2004, and 478 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 and investment powers with
respect to such shares; (B) 572 shares of Class A Common Stock and
15,082 shares of Class C Common Stock held by Associated Investors, a
Utah general partnership (including 27 shares of Class A Common Stock
and 718 shares of Class C Common Stock that were allocated to the
reporting persons 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; (C) 13,607 shares of Class A Common Stock and 169,016
shares of Class C Common Stock acquired under the Security National
Financial Corporation Employee Stock Ownership Plan (ESOP), in reliance
on old Rule 16a-8(g)(3) (including 648 shares of Class A Common Stock
and 8,048 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) 13,234 shares of Class A Common Stock acquired under the Security
National Financial Corporation Deferred Compensation Plan (including
2,895 shares of Class A Common Stock the reporting person acquired
under the Deferred Compensation Plan between April 1, 2004 and December
31, 2004, and 630 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 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 35,000 shares of Class
A Common Stock under the Security National Financial Corporation 1993
Stock Option Plan. The options became exercisable on March 21, 2003,
but any shares of Class A Common Stock acquired from the exercise of
the options shall be forfeited if the reporting person does not remain
employed by the Company for the later of (i) five years following the
date of grant or March 21, 2013, or (ii) two years following the date
these options have been exercised by the reporting person.
4/ Grant to reporting person of options to purchase 10,000 shares of Class
A Common Stock under the Security National Financial Corporation 2003
Stock Option Plan. The options became exercisable on December 10, 2004.
