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*
Butler Adrian M

(Last) (First) (Middle)
ONE SE CONVENIENCE BLVD.

(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)
Chief Information Officer
3. Date of Earliest Transaction (Month/Day/Year)
06/15/2022
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 06/15/2022 M 288 A $0 488 D
Common Stock 06/15/2022 M 291 A $0 779 D
Common Stock 06/15/2022 F 221 D $186.57(1) 558 D
Common Stock 137(2) I Voting and tender rights under 401k plan
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
Restricted stock units (3) 06/15/2022 M 288 (4) (4) Common Stock 288 $0 288 D
Restricted stock units (3) 06/15/2022 M 291 (5) (5) Common Stock 291 $0 584 D
Restricted stock units (3) (6) (6) Common Stock 2,656 2,656 D
Restricted stock units (3) (7) (7) Common Stock 985 985 D
Explanation of Responses:
1. Closing price of Casey's General Stores, Inc. Common Stock on June 15, 2022.
2. Allocated to Mr. Butler's 401k plan account as of April 30, 2022. Does not include any shares allocated by the plan trustee after that date.
3. Each restricted stock unit represents the right to receive, following vesting, one share of Common Stock.
4. Pursuant to terms and conditions of 2018 Stock Incentive Plan. The remainder of this award will vest on June 15, 2023. Not included in the reported award amount is a target amount of performance-based restricted stock units that will vest on June 15, 2023, but which are subject to the satisfaction of certain performance criteria other than solely the price of Casey's Common Stock; the final amount of shares earned, if any, will be reported upon vest and satisfaction of those performance measures.
5. Pursuant to terms and conditions of 2018 Stock Incentive Plan. The remainder of this award will vest in equal installments on June 15, 2023 and June 15, 2024. Not included in the reported award amount is a target amount of performance-based restricted stock units that will vest on June 15, 2024, but which are subject to the satisfaction of certain performance criteria other than solely the price of Casey's Common Stock; the final amount of shares earned, if any, will be reported upon vest and satisfaction of those performance measures.
6. Pursuant to terms and conditions of 2018 Stock Incentive Plan and in accordance with the terms and conditions of Mr. Butler's "make-whole award" of June 1, 2020, granted in conjunction with his commencement of employment as Casey's Chief Information Officer. This award will vest in-full on June 1, 2023.
7. Pursuant to terms and conditions of 2018 Stock Incentive Plan. This award will vest in equal installments on June 15, 2023, June 15, 2024 and June 15, 2025. Not included in the reported award amount is a target amount of performance-based restricted stock units that will vest on June 15, 2025, but which are subject to the satisfaction of certain performance criteria other than solely the price of Casey's Common Stock; the final amount of shares earned, if any, will be reported upon vest and satisfaction of those performance measures.
Remarks:
Scott Faber, under Power of Attorney dated June 3, 2020 06/17/2022
** 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).
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