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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
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 | ||||||||
Non-Voting Common Stock | (5) | 05/30/2012 | P | 1,464,540 (1) | (5) | (4) | Common Stock | 1,464,540 | $ 1 | 15,178,733 | I (2) | By Stadium Capital Partners, L.P. | |||
Non-Voting Common Stock | (5) | 05/30/2012 | P | 127,351 (1) | (5) | (4) | Common Stock | 127,351 | $ 1 | 1,319,889 | I (3) | By Stadium Capital Qualified Partners, L.P. |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
STADIUM CAPITAL MANAGEMENT LLC 199 ELM STREET NEW CANAAN, CT 06840-5321 |
X | X | ||
SEAVER ALEXANDER M 199 ELM ST. NEW CANAAN, CT 06840 |
X | |||
KENT BRADLEY R 199 ELM STREET NEW CANAAN, CT 06840 |
X | |||
STADIUM CAPITAL PARTNERS L P 199 ELM STREET NEW CANAAN, CT 06840 |
X | X | ||
STADIUM CAPITAL QUALIFIED PARTNERS LP 199 ELM STREET NEW CANAAN, CT 06840 |
X |
Stadium Capital Management, LLC, by Bradley R. Kent, Manager | 05/30/2012 | |
**Signature of Reporting Person | Date | |
Alexander M. Seaver | 05/30/2012 | |
**Signature of Reporting Person | Date | |
Bradley R. Kent | 05/30/2012 | |
**Signature of Reporting Person | Date | |
Stadium Capital Partners, L.P., by Stadium Capital Management, LLC, its general partner, by Bradley R. Kent, Manager | 05/30/2012 | |
**Signature of Reporting Person | Date | |
Stadium Capital Qualified Partners, L.P., by Stadium Capital Management, LLC, its general partner, by Bradley R. Kent, Manager | 05/30/2012 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Pursuant to the Amended and Restated Securities Purchase Agreements, dated January 20, 2012 (the "Amended Purchase Agreements"), with Intermountain Community Bancorp, each of Stadium Capital Partners, L.P. and Stadium Capital Qualified Partners, L.P. agreed that in the event the rights offering required by the Amended Purchase Agreements (the "Rights Offering") was not fully subscribed, they would purchase shares of Common Stock and Non-Voting Common Stock representing in the aggregate their pro rata shares of the unsubscribed shares of Common Stock (the "Rights Offering Backstop"). On May 29, 2012, pursuant to the Rights Offering Backstop, Stadium Capital Partners, L.P. and Stadium Capital Qualified Partners, L.P. purchased from Intermountain 722,152 shares and 62,796 shares of Common Stock, respectively, and 1,464,540 shares and 127,351 shares of Non-Voting Common Stock, respectively. |
(2) | The reported securities are owned directly by Stadium Capital Partners, L.P., and indirectly by Stadium Capital Management, LLC as general partner of Stadium Capital Partners, L.P., Alexander M. Seaver as a manager of Stadium Capital Management, LLC, and Bradley R. Kent as a manager of Stadium Capital Management, LLC. Stadium Capital Management, LLC, Alexander M. Seaver and Bradley R. Kent disclaim beneficial ownership of the reported securities except to the extent of their respective pecuniary interests therein. |
(3) | The reported securities are owned directly by Stadium Capital Qualified Partners, L.P., and indirectly by Stadium Capital Management, LLC as general partner of Stadium Capital Qualified Partners, L.P., Alexander M. Seaver as a manager of Stadium Capital Management, LLC, and Bradley R. Kent as a manager of Stadium Capital Management, LLC. Stadium Capital Management, LLC, Alexander M. Seaver and Bradley R. Kent disclaim beneficial ownership of the reported securities except to the extent of their respective pecuniary interests therein. |
(4) | Expiration date is not applicable. |
(5) | Exercise date and price are not applicable. Pursuant to Intermountain's Amended and Restated Articles of Incorporation, any holder of Non-Voting Common Stock may convert shares of Non-Voting Common Stock into an equal number of shares of Common Stock in connection with certain transfers of such shares of Non-Voting Common Stock. |
Remarks: Stadium Capital Partners, L.P. and Stadium Capital Qualified Partners, L.P. are jointly entitled to appoint a representative to Intermountain's board of directors pursuant to their respective securities purchase agreements as reported by Intermountain in a Form 8-K filed with the SEC on 1/23/12. John L. Welborn Jr. was appointed to the board of Intermountain pursuant to these contractual rights. |