SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 04/01/2020 | 3. Issuer Name and Ticker or Trading Symbol Reliant Bancorp, Inc. [ RBNC ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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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 | 31,848 | D | |
Common Stock | 3,628 | I | By First Advantage 401(k) Plan(1) |
Common Stock | 9,417 | I | By First Advantage ESOP(2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: 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 |
Explanation of Responses: |
1. Pursuant to the Agreement and Plan of Merger, dated October 22, 2019 (the "Merger Agreement"), by and among Bancorp, Inc. ("Reliant"), PG Merger Sub, Inc., and First Advantage Bancorp ("First Advantage"), each share held in the First Advantage Bank 401(k) & Profit Sharing Plan (the "First Advantage 401(k)") was also converted into the right to receive 1.17 shares of Reliant common stock and $3.00 in cash, without interest. Although the First Advantage 401(k) has technically been terminated, as of the date of this Form 4, the 3,628 shares in the 401(k) Plan have not yet been transferred to a new account due to administrative processing of transfer documentation. |
2. Pursuant to the Merger Agreement, each share held in the First Advantage Bank Employees Stock Ownership Plan ("ESOP") was converted into the right to receive 1.17 shares of Reliant common stock and $3.00 in cash, without interest. As of the date of this Form 4, the final number of ESOP shares allocable to the reporting person are not yet available. Accordingly, set forth above is the estimate of the number of shares of Reliant common stock known to be beneficially owned by the reporting person at this time. The reporting person will report the final stock ownership numbers once they are determined, if this number differs from the reported number. Additionally, although the ESOP has technically been terminated, the ESOP shares have not yet been transferred to a new account due to administrative processing of transfer documentation. |
Remarks: |
Exhibit List Exhibit 24 - Power of Attorney |
William Bettis, Attorney-in-Fact | 04/01/2020 | |
** 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 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). | ||
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. |