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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| 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)
| 2. Issuer Name and Ticker or Trading Symbol Triumph Bancorp, Inc. [ TBK ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 11/09/2017 | ||||||||||||||||||||||||||
| 4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock | 11/09/2017 | G | V | 2,569(1) | D | $0.00 | 62,495(2) | D | ||
| Common Stock | 11/13/2017 | J | 6,505(3) | A | (3) | 69,000(4) | D | |||
| Common Stock | 11/13/2017 | J | 9,764(3) | A | (3) | 75,979(5) | I | By Rick Davis 2006 Family Trust | ||
| Common Stock | 11/13/2017 | J | 9,764(3) | A | (3) | 75,979(6) | I | By Sheree Davis 2006 Children's Trust | ||
| 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) | 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 (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Explanation of Responses: |
| 1. Represents a bone fide gift to the Rick & Sheree Davis Family Foundation, a 501(c)(3) charitable organization. |
| 2. Consists of (i) 17,571 shares beneficially owned by reporting person, (ii) 44,429 shares of common stock held jointly with reporting person's spouse, Sheree Davis, and (iii) 495 shares of restricted stock of the reporting person subject to future time vesting requirements. |
| 3. Shares were distributed to the reporting person as the ultimate recipient of a distribution made by Triumph Consolidated Cos., LLC, under the terms of its operating agreement. See Footnote 1 to "Security Ownership of Certain Beneficial Owners and Management" of Issuer's most recent proxy statement on Form 14-A filed with the Securities and Exchange Commission on March 24, 2017. |
| 4. Consists of (i) 17,571 shares beneficially owned by reporting person, (ii) 50,934 shares of common stock held jointly with reporting person's spouse, Sheree Davis, and (iii) 495 shares of restricted stock of the reporting person subject to future time vesting requirements. |
| 5. These 75,979 shares are beneficially owned by reporting person as trustee of the Rick Davis 2006 Family Trust. Reporting person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. |
| 6. These 75,979 shares are beneficially owned by reporting person as trustee of the Sheree Davis 2006 Children's Trust. Reporting person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. |
| Remarks: |
| /s/ Adam D. Nelson, Attorney-in-fact | 11/15/2017 | |
| ** 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. | ||