Initial Statement of Beneficial Ownership (3)
06 Janeiro 2021 - 3:24PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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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1. Name and Address of Reporting Person
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Lemke Matthew R. |
2. Date of Event Requiring Statement (MM/DD/YYYY)
1/1/2021
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3. Issuer Name and Ticker or Trading Symbol
County Bancorp, Inc. [ICBK]
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(Last)
(First)
(Middle)
2400 S. 44TH STREET |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) CHIEF RETAIL & DEPOSIT OFFICER / |
(Street)
MANITOWOC, WI 54220
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
COMMON STOCK | 2319.0288 (1) | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 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) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
EMPLOYEE STOCK OPTION (Right to Buy) (2) | (3) | 9/20/2026 | COMMON STOCK | 1196 | $20.92 | D | |
EMPLOYEE STOCK OPTION (Right to Buy) (2) | (4) | 1/2/2029 | COMMON STOCK | 1418 | $17.64 | D | |
EMPLOYEE STOCK OPTION (Right to Buy) (2) | (5) | 3/13/2030 | COMMON STOCK | 2882 | $18.30 | D | |
Explanation of Responses: |
(1) | Includes 2,127 shares of restricted stock units granted under the County Bancorp, Inc. 2016 Long Term Incentive Plan (the "Plan") |
(2) | Stock option grant under the Plan |
(3) | The options vested in three equal installments on the first three anniversaries of the grant date, beginning September 20, 2017 |
(4) | The options vest in three equal installments on the first three anniversaries of the grant date, beginning January 2, 2020 |
(5) | The options vest in three equal installments on the first three anniversaries of the grant date, beginning March 13, 2021 |
Remarks: Exhibit List: Exhibit 24 - Power of Attorney |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Lemke Matthew R. 2400 S. 44TH STREET MANITOWOC, WI 54220 |
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| CHIEF RETAIL & DEPOSIT OFFICER |
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Signatures
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/s/ Mark A. Miller, POA | | 1/6/2021 |
**Signature of Reporting Person | Date |
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