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*
Jackowski Julia L

(Last) (First) (Middle)
ONE CONVENIENCE BLVD.
PO BOX 3001

(Street)
ANKENY IA 50021

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CASEYS GENERAL STORES INC [ CASY ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP, Corp Gen Counsel
3. Date of Earliest Transaction (Month/Day/Year)
06/29/2016
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 06/29/2016 M 3,000 A $26.92 21,939 D
Common Stock 06/29/2016 S 3,000 D $127.75 18,939 D
Common Stock 4,023 I Voting and tender rights under 401K plan(1)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Option - right to buy(2) $26.92 06/29/2016 M 3,000 06/25/2010 06/25/2017 Common Stock 3,000 $0 1,000 D
Option - right to buy(2) $25.26 06/23/2012 06/23/2019 Common Stock 12,500 12,500 D
Option - right to buy(3) $44.39 06/23/2014 06/23/2021 Common Stock 20,000 20,000 D
Restricted stock units(4) (5) (4) (4) Common Stock 3,250 3,250 D
Restricted stock units(6) (5) (6) (6) Common Stock 3,250 3,250 D
Restricted stock units(7) (5) (7) (7) Common Stock 3,250 3,250 D
Explanation of Responses:
1. Allocated to Ms. Jackowski's 401k plan account as of April 30, 2016. Does not include any shares allocated by the plan trustee after that date.
2. Pursuant to terms and conditions of 2000 Stock Option Plan.
3. Pursuant to terms and conditions of 2009 Stock Incentive Plan.
4. Pursant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 6, 2017.
5. Each restricted stock unit represents the right to receive, following vesting, one share of Common Stock.
6. Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 5, 2018.
7. Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 2, 2019.
Remarks:
William J. Noth, under POA dated June 8, 2010 07/01/2016
** 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.
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