SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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).
  
 Form 3 Holdings Reported.
  
 Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Walljasper William J
(Last) (First) (Middle)
ONE CONVENIENCE BLVD.
PO BOX 3001
(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)
Senior VP and CFO
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
04/30/2017
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 at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 12/23/2013 G5 150(1) D $0 19,386(2) D
Common Stock 07/02/2015 G5 200(1) D $0 19,386(2) D
Common Stock 12/21/2016 G5 100(1) D $0 19,386(2) D
Common Stock 6,437(3) 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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Option - right to buy(4) $25.26 06/23/2012 06/23/2019 Common Stock 15,300 15,300 D
Option - right to buy(5) $44.39 06/23/2014 06/23/2021 Common Stock 20,000 20,000 D
Restricted stock units(6) (7) (6) (6) Common Stock 3,250 3,250 D
Restricted stock units(8) (7) (8) (8) Common Stock 3,250 3,250 D
Restricted stock units(9) (7) (9) (9) Common Stock 3,250 3,250 D
Explanation of Responses:
1. The number of shares reported reflects a bona fide gift of shares to a charitable organization on the transaction date that has not been previously reported by Mr. Walljasper. The omitted shares also were included in the Table I, Column 5 beneficial ownership reported in the intervening Forms 4 and 4/A filed by Mr. Walljasper between the applicable transaction date and this Form 5.
2. Reflects the number of shares directly owned by Mr. Walljasper as of the end of Casey's fiscal year, April 30, 2017, taking into account the amendment reported on Form 4/A being filed with this Form 5.
3. Allocated to Mr. Walljasper's 401k plan account as of the end of Casey's fiscal year, April 30, 2017. Does not include any shares allocated by the plan trustee after that date.
4. Pursuant to terms and conditions of 2000 Stock Option Plan (or predecessor plan).
5. Pursuant to terms and conditions of 2009 Stock Incentive Plan.
6. Pursuant to terms and conditions of 2009 Stock Incentive Plan. As reported in the intervening Form 4 on June 6, 2017, this award vested in full on June 6, 2017; however, the holding (and the other holdings in Table II) reflects Mr. Walljasper's ownership of derivative securities as of the end of Casey's fiscal year, April 30, 2017.
7. Each restricted stock unit represents the right to receive, following vesting, one share of Common Stock.
8. Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 5, 2018.
9. Pursuant to terms and conditions of 2009 Stock Incentive Plan. This award will vest in full on June 2, 2019.
Remarks:
Scott Faber, under Power of Attorney dated March 3, 2017 07/18/2017
** 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.
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