|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Security: 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 | ||||||||
Employee Incentive Stock Option (Right to Buy) | $ 22 | 09/20/2005 | A | 2,500 | (7) | 09/19/2015 | Common Stock | 2,500 | $ 22 | 7,750 | D | ||||
Employee Incentive Stock Option (Right to Buy) | $ 20.25 (8) | (9) | 04/18/2013 | Common Stock | 2,750 (10) | 2,750 (11) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
TILLEY JAMES 81 RUTLAND STREET BUFFALO, NY 14220 |
X | President and CEO |
Michelle Baumgarden, Attorney in Fact for James Tilley | 09/22/2005 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | On December 30, 2004, the issuer distributed a 5% stock dividend payable to all holders of record of common stock on December 9, 2004. As a result, the listed owner received 68.777327 additional shares of common stock. |
(2) | This number reflects shares acquired through the Employee Stock Purchase Plan as follows: 250 shares July 2, 2004; 283 shares January 5, 2005; 307 shares July 1, 2005. |
(3) | This number reflects shares acquired under the Evans Bancorp, Inc. Dividend Reinvestment Plan as follows: 26.723346 shares in 2004; 18.212936 shares in April 2005. |
(4) | On December 30, 2004, the issuer distributed a 5% stock dividend payable to all holders of record of common stock on December 9, 2004. As a result, the listed owner received 5 additional shares of common stock. |
(5) | On December 30, 2004, the issuer distributed a 5% stock dividend payable to all holders of record of common stock on December 9, 2004. As a result, the listed owner received 0.101501 additional shares of common stock. |
(6) | This number reflects shares acquired under the Evans Bancorp, Inc. Dividend Reinvestment Plan as follows: 0.383622 shares in 2004; 0.193249 shares in April 2005. |
(7) | The Options shall be exercisable according to the following schedule: 50% of the shares of Common Stock subject to the Option - 1st year after the Date of Grant; and 50% of the shares of Common Stock subject to the Option - 18 months after the Date of Grant and thereafter. |
(8) | This Option price was previously reported as an Option for 2,500 shares of Common Stock at an exercise price of $22.28 per share, but was adjusted to reflect the 5% stock dividend declared by Evans Bancorp, Inc. on November 16, 2004, payable on December 30, 2004 to shareholders of record on December 9, 2004. As a result of the stock dividend, pursuant to the anti-dilution provisions of Evans Bancorp, Inc.'s 1999 Stock Option and Long-Term Incentive Plan, the option entitled the reporting person to receive, upon exercise, 250 additional shares of Common Stock for no additional consideration. Also as a result of the 5% stock dividend, the exercise price of the option is adjusted from $22.28 per share to $20.25 per share. |
(9) | The Options shall be exercisable according to the following schedule: 50% of the shares of Common Stock subject to the Option - 1st year after the Date of Grant; and 50% of the shares of Common Stock subject to the Option - 2nd year after the Date of Grant and thereafter. |
(10) | This Option was previously reported as an Option for 2500 shares of Common Stock at an exercise price of $22.28 per share, but was adjusted to reflect the 5% stock dividend declared by Evans Bancorp, Inc. on November 16, 2004, payable on December 30, 2004 to shareholders of record on December 9, 2004. As a result of the stock dividend, pursuant to the anti-dilution provisions of Evans Bancorp, Inc.'s 1999 Stock Option and Long-Term Incentive Plan, the Option entitled the reporting person to receive, upon exercise, 250 additional shares of common stock for no additional consideration. |
(11) | This number is reflected in Section 9 (Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)) for Employee Incentive Stock Option (Right to Buy) reported as transaction date 09/20/2005. |