-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, M8Ojbg2/rf3dfKKtG87RLke1/4ZeJXEtKxqNM5BqWFL1DZsyXxN1GyG46idouZEs kh/jz7U389DIDgX7Um4V0w== 0001104659-03-000168.txt : 20030114 0001104659-03-000168.hdr.sgml : 20030114 20030109141022 ACCESSION NUMBER: 0001104659-03-000168 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030107 FILED AS OF DATE: 20030109 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: ANDERSON MARK A CENTRAL INDEX KEY: 0001185784 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 520 MAIN AVE. CITY: FARGO STATE: ND ZIP: 58124 BUSINESS PHONE: 7012985625 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: COMMUNITY FIRST BANKSHARES INC CENTRAL INDEX KEY: 0000857593 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 460391436 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19368 FILM NUMBER: 03509006 BUSINESS ADDRESS: STREET 1: 520 MAIN AVENUE CITY: FARGO STATE: ND ZIP: 58124-0001 BUSINESS PHONE: 7012985600 MAIL ADDRESS: STREET 1: 520 MAIN AVENUE CITY: FARGO STATE: ND ZIP: 58124-0001 4 1 j6545_4.htm 4

FORM 4

  o   Check this box if no longer subject to Section 16.  Form 4 or Form 5 obligations may continue.
See Instruction 1(b).

(Print or Type Responses)

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, 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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 1. Name and Address of Reporting Person *



Anderson,   Mark   A.

(Last)            (First)              (Middle)


520 Main Avenue

(Street)


Fargo, ND  58124

(City)       (State)          (Zip)

 

 2. Issuer Name and Ticker
    or Trading Symbol

Community First Bankshares, Inc.
CFBX

 



 3. I.R.S. Identification
    Number of Reporting
    Person, if an entity
    (voluntary)



 4. Statement for
 (Month/Day/Year)

January 7,  2003





 5. If Amendment, Date of
   Original (Month/Day/Year)



 6. Relationship of Reporting Person(s) to Issuer

     (Check all applicable)

         Director

 

         10% Owner

 

   X    Officer (give title below)

 

          Other (specify below)

President & CEO

 


 7. 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 (CFBX)

1/7/03

 

M

 

20,000

A

$19.5625

 

 

 

 

1/7/03

 

F

 

14,368

D

$27.23

 

 

 

 

1/7/03

 

F(a)

 

1,611

D

$27.23

285,184

D

 

 

 

 

 

 

 

 

 

3,277

I

Uniform Gift to Minors

 

 

 

 

 

 

 

 

9,068 (b)

I

401(k)

 

 

 

 

 

 

 

 

6,289 (c )

I

SERP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(a)     Securities sold at exercise to facilitate withholding relative to non-qualified options.

(b)     Includes 14,548 shares sold, not previously reported.

(c)     Includes 2,209 shares sold, not previously reported.

 


 

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 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 Securities: 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

19.5625

1/7/03

 

M

 

 

20,000

(1)

2/2/09

Common Stock

40,000

 

0

D

 

Option 

14.00

 

 

 

 

 

 

(1)

2/8/10

Common Stock

60,000

 

40,000

D

 

Option

19.3125

 

 

 

 

 

 

(1)

2/6/11

Common Stock

50,000

 

41,666

D

 

Option 

24.25

 

 

 

 

 

 

(1)

2/5/12

Common Stock

60,000

 

60,000

D

 

Option

26.25

 

 

 

 

 

 

(2)

2/2/09

Common Stock

14,904

 

14,904

D

 

Option

26.25

 

 

 

 

 

 

(3)

2/8/10

Common Stock

10,666

 

10,666

D

 

Option 

26.25

 

 

 

 

 

 

(4)

2/6/11

Common Stock

6,131

 

6,131

D

 

Option

$27.23

 

 

 

 

 

 

(2)

2/2/09

Common Stock

15,979

 

15,979

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Option (Right to buy)

 

 Explanation of Responses:

(1)     The option becomes exercisable with respect to one-third of the shares per year, commencing one year from the date of grant, which is also nine years prior to the expiration date.

(2)     Option acquired via reload feature of $19.5625 option grant.

(3)     Option acquired via reload feature of $14.00 option grant.

(4)     Option acquired via reload feature of $19.3125 option grant.

 

 

 

/s/  Mark A. Anderson

 

1/7/03

** 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.

 

 

http://www.sec.gov/divisions/corpfin/forms/form4.htm

Last update: 09/05/2002

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