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.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
SMITH JAMES E/MO

(Last) (First) (Middle)
517 SOUTH SECOND STREET

(Street)
CLINTON MO 64735

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
EXCHANGE NATIONAL BANCSHARES INC [ EXJF ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chairman & CEO
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2004
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 11/24/2004 11/24/2004 P4 110 A $29 18,845.637(1) D
Common Stock 11/24/2004 11/24/2004 P4 50 A $29 18,895.637 D
Common Stock 11/29/2004 11/29/2004 P4 40 A $28.9 18,935.637 D
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
Employee Stock Option (Right to buy) $16.33 12/04/2001(2) 12/04/2010 Common Stock 7,959 7,959 D
Employee Stock Option (Right to buy) $18.67 02/14/2003(3) 02/14/2012 Common Stock 7,500 7,500 D
Employee Stock Option (Right to buy) $26.57 03/03/2004(4) 03/03/2013 Common Stock 8,323 8,323 D
Employee Stock Option (Right to buy) $35.25 02/19/2005(5) 02/19/2014 Common Stock 7,376 7,376 D
Explanation of Responses:
1. Includes 132.921 shares acquired since date of last report pursuant to Company DRIP program.
2. 25% per year beginning 2001-12-04.
3. 25% per year beginning 2003-02-14.
4. 1222 vest after 1st year. 1222 vest after 2nd year. 2449 vest after 3rd year. 3430 vest after 4th year.
5. 1452 vest after 1st year. 252 vest after 3rd yr. 2836 vest after 4th year. 2836 vest after 4th year.
/s/ Kathleen L. Bruegenhemke, Attorney in Fact 02/11/2005
** 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.
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 Number.