Ownership Submission
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
(e.g., puts, calls, warrants, options, convertible securities)
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
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FORM 5
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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 or Section 30(h) of the Investment Company Act of 1940 |
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(e.g., puts, calls, warrants, options, convertible securities)
| 1. Title of Derivate Security | 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 | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security | 8. Price of Derivative Security | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) | 11. Nature of Indirect Beneficial Ownership |
| (A) | (D) | Date Exercisable | Expriation Date | Title | Amount or Number of Shares |
Reporting Owners
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
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QUIST SCOTT M 7 WANDERWOOD WAY SANDY, UT84092 |
X | X | Board Chair, Pres, CEO |
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Signatures
| /s/ Scott M. Quist | 2022-02-03 |
| **Signature of Reporting Person | Date |
Explanation of Responses:
| (*) | 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 an exchange of shares of Class A Common Stock from the George R. and Shirley C. Quist Family Partnership Ltd. (the "Family Partnership") to the reporting person. |
| (2) | Pursuant to an exchange of shares of Class C Common Stock from the reporting person to the Family Partnership. |
| (3) | This option was granted on December 2, 2016 as an option for either 80,000 shares of Class A Common Stock at an exercise price of $7.73 per share or 80,000 shares of Class C Common Stock at an exercise price of $7.73 per share, or any combination thereof. This option reflects the reporting person's election to have an option for 80,000 shares of Class C Common Stock at an exercise price of $7.73 per share, but adjusted pursuant to the anti-dilution provisions of the 2013 Stock Option Plan to reflect 5% stock dividends paid on February 3, 2017, February 2, 2018, February 1, 2019, and February 7, 2020; a 2 1/2% stock dividend paid on July 17, 2020, and a 5% stock dividend paid on July 16, 2021. |
| (4) | This option was granted on December 1, 2017 as an option for 75,000 shares of Class A Common Stock at an exercise price of $5.56 per share, but adjusted pursuant to the anti-dilution provisions of the 2013 Stock Option Plan to reflect 5% stock dividends paid on February 2, 2018, February 1, 2019, and February 7, 2020; a 2 1/2% stock dividend paid on July 17, 2020, and a 5% stock dividend paid on July 16, 2021. |
| (5) | This option was granted on November 30, 2018 as an option for 70,000 shares of Class A Common Stock at an exercise price of $6.07 per share, but adjusted pursuant to the anti-dilution provisions of the 2013 Stock Option Plan to reflect a 5% stock dividend paid on February 1, 2019, a 2 1/2% stock dividend paid on July 17, 2020, and a 5% stock dividend paid on July 16, 2021. |
| (6) | This option was granted on December 6, 2019 as an option for either 50,000 shares of Class A Common Stock at an exercise price of $6.01 per share or 50,000 shares of Class C Common Stock at an exercise price of $6.01 per share, or any combination thereof. This option reflects the reporting person's election to have an option for 50,000 shares of Class C Common Stock at an exercise price of $6.01 per share, but adjusted pursuant to the anti-dilution provisions of the 2013 Stock Option Plan to reflect 5% stock dividends paid on February 3, 2017, February 2, 2018, February 1, 2019, and February 7, 2020; a 2 1/2% stock dividend paid on July 17, 2020, and a 5% stock dividend paid on July 16, 2021. |
| (7) | This option was granted on March 27, 2020 as an option for either 50,000 shares of Class A Common Stock at an exercise price of $4.16 per share or 50,000 shares of Class C Common Stock at an exercise price of $4.16 per share, or any combination thereof. This option reflects the reporting person's election to have an option for 50,000 shares of Class C Common Stock at an exercise price of $4.16 per share, a 2 1/2% stock dividend paid on July 17, 2020, and a 5% stock dividend paid on July 16, 2021. |
| (8) | This option was granted on December 3, 2021 as an option for either 50,000 shares of Class A Common Stock at an exercise price of $9.48 per share or 50,000 shares of Class C Common Stock at an exercise price of $9.48 per share, or any combination thereof. This option reflects the reporting person's election to have an option for 50,000 shares of Class C Common Stock at an exercise price of $9.48 per share. The option vests in four quarterly installments of Class C Common Stock, beginning on March 3, 2022, until such shares are fully vested. |
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Disclaimer
SNFC - Security National Financial Corporation published this content on 03 February 2022 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 04 February 2022 01:02:08 UTC.
