-----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, Q1v6g5VKebi+6hUmvsiAPYGMT8an1kkDthrkG2VVBBrevG0prmd9FHgj6hJltZa4 5Fn1okgAM5lS+Z/Zhep9/g== 0000913849-04-000094.txt : 20040213 0000913849-04-000094.hdr.sgml : 20040213 20040213171653 ACCESSION NUMBER: 0000913849-04-000094 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040213 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PARK BANCORP INC CENTRAL INDEX KEY: 0001013554 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 364082530 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-49477 FILM NUMBER: 04600473 BUSINESS ADDRESS: STREET 1: 500 WASHINGTON ST CITY: COLUMBUS STATE: IL ZIP: 47201 BUSINESS PHONE: 7735828616 MAIL ADDRESS: STREET 1: 5400 SOUTH PULASKI ROAD CITY: CHICAGO STATE: IL ZIP: 60632 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: POKRAK STEVEN J CENTRAL INDEX KEY: 0001167236 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 5400 SOUTH PULASKI ROAD CITY: CHICAGO STATE: IL ZIP: 60632 SC 13G/A 1 sc13ga_021204.txt AMENDMENT NO. 2 TO SCHEDULE 13G SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 SCHEDULE 13G (Rule 13d-102) INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1(b)(c), AND (d) AND AMENDMENTS THERETO FILED PURSUANT TO RULE 13d-2(b) (Amendment No. 2) PARK BANCORP, INC. - -------------------------------------------------------------------------------- (Name of Issuer) COMMON STOCK - -------------------------------------------------------------------------------- (Title of Class of Securities) 700164106 - -------------------------------------------------------------------------------- (CUSIP Number) DECEMBER 31, 2003 - -------------------------------------------------------------------------------- (Date of Event Which Requires Filing of this Statement) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: [_] Rule 13d-1(b) [X] Rule 13d-1(c) [_] Rule 13d-1(d) The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). CUSIP No. 700164106 13G Page 2 of 5 Pages ________________________________________________________________________________ 1. NAME OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) STEVEN J. POKRAK ________________________________________________________________________________ 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [_] (b) [_] NOT APPLICABLE ________________________________________________________________________________ 3. SEC USE ONLY ________________________________________________________________________________ 4. CITIZENSHIP OR PLACE OF ORGANIZATION U.S. CITIZEN ________________________________________________________________________________ NUMBER OF 5. SOLE VOTING POWER SHARES 55,786 _________________________________________________________________ BENEFICIALLY 6. SHARED VOTING POWER OWNED BY 13,510 _________________________________________________________________ EACH 7. SOLE DISPOSITIVE POWER REPORTING 55,786 _________________________________________________________________ PERSON 8. SHARED DISPOSITIVE POWER WITH 0 ________________________________________________________________________________ 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 69,296 ________________________________________________________________________________ 10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [X] ________________________________________________________________________________ 11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 6.0% ________________________________________________________________________________ 12. TYPE OF REPORTING PERSON* IN ________________________________________________________________________________ *SEE INSTRUCTIONS BEFORE FILLING OUT! CUSIP No. 700164106 13G Page 3 of 5 Pages Item 1(a). Name of Issuer: Park Bancorp, Inc. ____________________________________________________________________ Item 1(b). Address of Issuer's Principal Executive Offices: 5400 S. Pulaski, Chicago, Illinois 60632 ____________________________________________________________________ Item 2(a). Name of Person Filing: Steven J. Pokrak ____________________________________________________________________ Item 2(b). Address of Principal Business Office, or if None, Residence: 5400 S. Pulaski, Chicago, Illinois 60632 ____________________________________________________________________ Item 2(c). Citizenship: U.S. Citizen ____________________________________________________________________ Item 2(d). Title of Class of Securities: Common Stock ____________________________________________________________________ Item 2(e). CUSIP Number: 700164106 ____________________________________________________________________ Item 3. If This Statement is Filed Pursuant to Rule 13d-1(b), or 13d-2(b) or (c), Check Whether the Person Filing is a: (a) [_] Broker or dealer registered under Section 15 of the Exchange Act. (b) [_] Bank as defined in Section 3(a)(6) of the Exchange Act. (c) [_] Insurance company as defined in Section 3(a)(19) of the Exchange Act. (d) [_] Investment company registered under Section 8 of the Investment Company Act. (e) [_] An investment adviser in accordance with Rule 13d-1(b)(1)(ii)(E); (f) [_] An employee benefit plan or endowment fund in accordance with Rule 13d-1(b)(1)(ii)(F); (g) [_] A parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G); (h) [_] A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act; (i) [_] A church plan that is excluded from the definition of an investment company under Section 3(c)(14) of the Investment Company Act; (j) [_] Group, in accordance with Rule 13d-1(b)(1)(ii)(J). CUSIP No. 700164106 13G Page 4 of 5 Pages Item 4. Ownership. Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1. (a) Amount beneficially owned: 69,296 ______________________________________________________________________ (b) Percent of class: 6.0% ______________________________________________________________________ (c) Number of shares as to which such person has: (i) Sole power to vote or to direct the vote: 55,786, (ii) Shared power to vote or to direct the vote: 13,510, (iii) Sole power to dispose or to direct the disposition of: 55,786, (iv) Shared power to dispose or to direct the disposition of: 0 The amount beneficially owned by Mr. Pokrak includes 2,000 shares subject to stock options that are currently exercisable or exercisable within 60 days from December 31, 2003, and 13,510 shares allocated to his account pursuant to the Employee Stock Ownership Plan for Park Federal Savings Bank (the "Bank") to which there is shared voting power with the plan trustee. Mr. Pokrak disclaims beneficial ownership of 55,825 shares held in the Bank's 401(k) Plan to which members of the Advisory Plan Committee for the 401(k) Plan share voting power. The disclaimed shares are not included in Mr. Pokrak's aggregate beneficial ownership. Item 5. Ownership of Five Percent or Less of a Class. If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities check the following [ ]. Not applicable _______________________________________________________________________ Item 6. Ownership of More Than Five Percent on Behalf of Another Person. Not applicable _______________________________________________________________________ Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company or Control Person. Not applicable _______________________________________________________________________ Item 8. Identification and Classification of Members of the Group. Not applicable _______________________________________________________________________ Item 9. Notice of Dissolution of Group. Not applicable ______________________________________________________________________ Item 10. Certifications. By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having such purpose or effect. SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. Dated: February 13, 2004 /s/ Steven J. Pokrak ------------------------- Name: Steven J. Pokrak -----END PRIVACY-ENHANCED MESSAGE-----