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)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/10/2019 |
3. Issuer Name and Ticker or Trading Symbol
HBT Financial, Inc. [ HBT ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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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, $0.01 par value | 5,939,880(1) | I | See Footnote(1) |
Common Stock, $0.01 par value | 11,318(2) | I | See Footnote(2) |
Common Stock, $0.01 par value | 200,980(3) | I | See Footnote(3) |
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. The reporting person is the trustee of the George E. Drake Inter-Vivos Family Trust (the "Inter-Vivos Trust") and may be deemed to be the beneficial owner of shares held by the Inter-Vivos Trust to the extent that he or his immediate family members are beneficiaries of such trust. The Inter-Vivos Trust's interest in the common stock is represented by trust certificates issued by the Heartland Bancorp, Inc. Voting Trust U/A/D May 4, 2016 (the "Voting Trust"), which are held by the Inter-Vivos Trust. The reporting person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. |
2. The reporting person's interest in the common stock is represented by trust certificates issued by the Voting Trust held by the reporting person. |
3. The reporting person's interest in the common stock is represented by trust certificates issued by the Voting Trust held by the reporting person's spouse. The reporting person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. |
Remarks: |
Exhibit 24.1 - Power of Attorney |
/s/ Andrea E. Zurkamer, attorney-in-fact | 10/10/2019 | |
** 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. |