-----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, RJa7sPqPsZ0HmaLUJLNoM/LEjg0HowReulbVAeLm2J007k+8HHC2CcXPgjI8rDfe Ek/RSF4JKoz11ELh253fAg== 0000950137-04-000969.txt : 20040213 0000950137-04-000969.hdr.sgml : 20040213 20040213172414 ACCESSION NUMBER: 0000950137-04-000969 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040213 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: EXCHANGE NATIONAL BANCSHARES INC CENTRAL INDEX KEY: 0000893847 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] IRS NUMBER: 431626350 STATE OF INCORPORATION: MO FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-49021 FILM NUMBER: 04600671 BUSINESS ADDRESS: STREET 1: 132 EAST HIGH STREET CITY: JEFFERSON CITY STATE: MO ZIP: 65101 BUSINESS PHONE: (573)761-6100 MAIL ADDRESS: STREET 1: P.O. BOX 688 CITY: JEFFERSON CITY STATE: MO ZIP: 65102 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: CAMPBELL DONALD L CENTRAL INDEX KEY: 0000939203 IRS NUMBER: 500240720 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 132 EAST HIGH STREET CITY: JEFFERSON CITY STATE: MO ZIP: 65101 BUSINESS PHONE: 5737616100 MAIL ADDRESS: STREET 1: 132 EAST HIGH ST CITY: JEFFERSON CITY STATE: MO ZIP: 65101 SC 13G/A 1 c82914sc13gza.txt AMENDMENT TO SCHEDULE 13G OMB APPROVAL -------------------------- OMB Number: 3235-0145 Expires: December 31, 2005 Estimated average burden hours per response......11 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. 5)* EXCHANGE NATIONAL BANCSHARES, INC. - -------------------------------------------------------------------------------- (Name of Issuer) COMMON STOCK - $1.00 PAR SHARE - -------------------------------------------------------------------------------- (Title of Class of Securities) 301309100 - -------------------------------------------------------------------------------- (CUSIP Number) - -------------------------------------------------------------------------------- (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) [ ] Rule 13d-1(c) [ ] Rule 13d-1(d) *The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. 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 ("Act") 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). 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 1745 (12-02) CUSIP NO. 301309100 13G Page 2 of 8 Pages - -------------------------------------------------------------------------------- 1. Names of Reporting Persons. I.R.S. Identification Nos. of above persons (entities only). DONALD L. CAMPBELL #500 24 0720 - -------------------------------------------------------------------------------- 2. Check the Appropriate Box if a Member of a Group (See Instructions) (a) [ ] NOT APPLICABLE ----------------------------------------------------------------- (b) [ ] NOT APPLICABLE ----------------------------------------------------------------- - -------------------------------------------------------------------------------- 3. SEC Use Only - -------------------------------------------------------------------------------- 4. Citizenship or Place of Organization UNITED STATES CITIZEN - -------------------------------------------------------------------------------- Number of 5. Sole Voting Power 214,039.5174 Shares ----------------------------------------------------- Beneficially 6. Shared Voting Power 0 Owned by ----------------------------------------------------- Each 7. Sole Dispositive Power 158,340 Reporting ----------------------------------------------------- Person With: 8. Shared Dispositive Power 0 - -------------------------------------------------------------------------------- 9. Aggregate Amount Beneficially Owned by Each Reporting Person 214,039.5174 - -------------------------------------------------------------------------------- 10. Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) N/A - -------------------------------------------------------------------------------- 11. Percent of Class Represented by Amount in Row (9) 5.1% - -------------------------------------------------------------------------------- 12. Type of Reporting Person (See Instructions) IN - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- Page 3 of 5 Pages ITEM 1: (a) Name of Issuer: Exchange National Bancshares, Inc. (b) Address of Issuer's Principal Executive Offices: 132 East High Street Jefferson City, Missouri 65101 ITEM 2: (a) Name of Person Filing: This Schedule 13G is filed Pursuant to Rule 13d-1 (C) of the Securities and Exchange Act of 1934, as amended. It is filed by the following person: Donald L. Campbell ("Mr. Campbell"). (b) Address of Principal Business Office or, if none, Residence: The business address for Mr. Campbell is 132 East High Street, Jefferson City, Missouri 65101. (c) Citizenship: Mr. Campbell is a United States citizen (d) Title of Class of Securities: Common stock, par value $1.00 per share. (e) CUSIP No.: 301309 10 0 ITEM 3: If this statement is filed pursuant to Rules 13d-1 (b), or 13d-2 (b), check whether the person filing is a: Not applicable. ITEM 4: Ownership (as of December 31, 2003) (a) Amount beneficially owned: Mr. Campbell may be deemed the beneficial owner of (i) 155,178 shares owned of record by Campbell Family L. P., which currently holds all shares previously owned of record by Mr. Campbell and his wife, and (ii) 55,699.5174 shares held in The Exchange National Bank of Jefferson City Profit Sharing Trust for the benefit of Mr. Campbell, and (iii) 3,162 shares owned solely by Mr. Campbell. Mr. Campbell has sole voting and investment power over the 155,178 shares owned of record by Campbell Family L. P. and the 3,162 shares owned solely by himself. Mr. Campbell has sole voting power, but no investment power, with respect to the 55,699.5174 shares held in The Exchange National Bank of Jefferson City, Profit Sharing Trust for his benefit. Page 4 of 5 Pages (b) Percent of class: The shares identified in paragraph (a) above as being beneficially owned by Mr. Campbell represent 5.1 % of the 4,169,847 shares outstanding on December 31, 2003. (c) Number of shares of which such person has: (I) sole power to vote or to direct the vote: 214,039.5174 shares. (ii) shared power to vote or to direct the vote: - 0 - shares. (iii) sole power to dispose or to direct the disposition of: 158,340 shares. (iv) shared power to dispose or to direct the disposition of: - 0 - shares. ITEM 5: Ownership of Five Percent or Less of a Class. 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. Not applicable. ITEM 8: Identification and Classification of Members of the Group. Not applicable. ITEM 9: Notice of Dissolution of Group. Not applicable. Page 5 of 5 Pages ITEM 10: Certification. Not applicable. 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 11, 2004 BY: /s/ Donald L. Campbell --------------------------- Donald L. Campbell -----END PRIVACY-ENHANCED MESSAGE-----