-----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, VCZMuGANUp+cOCIf96tQhZDM/3OQ2ouBxz0v7W3QBn8YZrcn6A8DYTaBhTwcycp4 4GFVkPXQpsvLlCSVqGnorQ== 0001104659-03-000578.txt : 20030123 0001104659-03-000578.hdr.sgml : 20030123 20030123171244 ACCESSION NUMBER: 0001104659-03-000578 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030122 FILED AS OF DATE: 20030123 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: STAPLES PATRICIA J CENTRAL INDEX KEY: 0001185798 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: 03522808 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 j6790_4.htm 4

FORM 4

      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 *



Staples,   Patricia    J

(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 22,  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)

Senior Vice President-Market Development

 


 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

1/22/03

 

M

 

10,000

A

$24.875

 

 

 

 

1/22/03

 

F

 

9,758

D

$25.49

10,463

D

 

 

 

 

 

 

 

 

 

1,254(a)

I

401(k)

 

 

 

 

 

 

 

 

3,348(b)

I

SERP

8.125% Cumulative Capital Securities (CFBXN)

 

 

 

 

 

 

 

2,070

I

Spouse

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(a)  Includes 38 shares purchased, not previously reported.

(b)  Includes 1,653 shares purchased, 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*

24.875

1/22/03

 

M

 

 

10,000

(1)

2/3/03

Common Stock

10,000

 

0

D

 

Option*

19.5625

 

 

 

 

 

 

(2)

2/2/09

Common Stock

8,000

 

8,000

D

 

Option*

14.00

 

 

 

 

 

 

(2)

2/8/10

Common Stock

12,000

 

12,000

D

 

Option*

19.3125

 

 

 

 

 

 

(2)

2/6/11

Common Stock

10,000

 

10,000

D

 

Option*

24.25

 

 

 

 

 

 

(2)

2/5/12

Common Stock

10,000

 

10,000

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Right to Buy

 

 Explanation of Responses:

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

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

 

 

 

 

/s/ Patricia J. Staples

** Signature of Reporting Person

January 22, 2003

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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