0001140361-13-000895.txt : 20130103 0001140361-13-000895.hdr.sgml : 20130103 20130103211837 ACCESSION NUMBER: 0001140361-13-000895 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121231 FILED AS OF DATE: 20130103 DATE AS OF CHANGE: 20130103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ludwig Eugene CENTRAL INDEX KEY: 0001453863 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-30248 FILM NUMBER: 13509605 MAIL ADDRESS: STREET 1: 280 PARK AVENUE, 40TH FLOOR WEST STREET 2: SUITE 401 CITY: NEW YORK STATE: NY ZIP: 10017 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: JACKSONVILLE BANCORP INC /FL/ CENTRAL INDEX KEY: 0001071264 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 593472981 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 NORTH LAURA STREET, SUITE 1000 CITY: JACKSONVILLE STATE: FL ZIP: 32202 BUSINESS PHONE: 9044213040 MAIL ADDRESS: STREET 1: 100 NORTH LAURA STREET, SUITE 1000 CITY: JACKSONVILLE STATE: FL ZIP: 32202 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CapGen Capital Group IV LP CENTRAL INDEX KEY: 0001505877 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-30248 FILM NUMBER: 13509603 BUSINESS ADDRESS: STREET 1: 280 PARK AVENUE, 4-TH FLOOR WEST CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 212-542-6868 MAIL ADDRESS: STREET 1: 280 PARK AVENUE, 4-TH FLOOR WEST CITY: NEW YORK STATE: NY ZIP: 10017 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CapGen Capital Group IV LLC CENTRAL INDEX KEY: 0001505878 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-30248 FILM NUMBER: 13509604 BUSINESS ADDRESS: STREET 1: 280 PARK AVENUE, 40TH FLOOR WEST CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 212-542-6868 MAIL ADDRESS: STREET 1: 280 PARK AVENUE, 40TH FLOOR WEST CITY: NEW YORK STATE: NY ZIP: 10017 4 1 doc1.xml FORM 4 X0306 4 2012-12-31 0 0001071264 JACKSONVILLE BANCORP INC /FL/ JAXB 0001505877 CapGen Capital Group IV LP 1185 AVENUE OF THE AMERICAS SUITE 2000 NEW YORK NY 10036 1 0 1 1 See Remarks 0001453863 Ludwig Eugene 1185 AVENUE OF THE AMERICAS SUITE 2000 NEW YORK NY 10036 1 0 1 1 See Remarks 0001505878 CapGen Capital Group IV LLC 1185 AVENUE OF THE AMERICAS SUITE 2000 NEW YORK NY 10036 1 0 1 1 See Remarks Series B Preferred Stock 2012-12-31 4 S 0 5000 D 0 I Held by CapGen Capital Group IV LP Series A Mandatorily Convertible Preferred Stock 2012-12-31 4 P 0 5000 5000000 A 5000 I Held by CapGen Capital Group IV LP Series A Mandatorily Convertible Preferred Stock 2012-12-31 4 P 0 22530 22530000 A 22530 I Held by CapGen Capital Group IV LP Series A Mandatorily Convertible Preferred Stock 2012-12-31 4 P 0 830 830000 A 830 D The shares reported in this row are owned directly by CapGen Capital Group IV LP ("CapGen LP"). CapGen Capital Group IV LLC ("CapGen LLC") is the sole general partner of CapGen LP. Mr. Eugene A. Ludwig is the managing member of CapGen LLC. As the sole general partner of CapGen LP, CapGen LLC may be deemed to be the indirect beneficial owner of the shares reported in this row under Rule 16a-1(a)(2) promulgated under the Securities Exchange Act of 1934, as amended (the "Exchange Act"). Pursuant to Rule 16a-1(a)(4) promulgated under the Exchange Act, CapGen LLC disclaims that it is the beneficial owner of such shares, except to the extent of its pecuniary interest. As the managing member of CapGen LLC, Mr. Ludwig may be deemed to be the indirect beneficial owner of the shares reported in this row under Rule 16a-1(a)(2) promulgated under the Exchange Act. Pursuant to Rule 16a-1(a)(4) promulgated under the Exchange Act, Mr. Ludwig disclaims that he is the beneficial owner of such shares, except to the extent of his pecuniary interest. Upon receipt of regulatory approval, the Noncumulative, Nonvoting Perpetual Preferred Stock, Series B (the "Series B Preferred Stock") of Jacksonville Bancorp, Inc. (the "Issuer") became exchangeable, on a one-for-one basis, into shares of Series A Mandatorily Convertible, Noncumulative, Nonvoting Perpetual Preferred Stock, Series A (the "Series A Preferred Stock"). On December 31, 2012, all 5,000 shares of Series B Preferred Stock held by the Reporting Persons were exchanged into 5,000 shares of Series A Preferred Stock. Mr. Ludwig directly owns the shares reported in this row. Upon receipt of requisite shareholder approvals, each share of Series A Preferred Stock will convert into 2,000 shares of common stock and/or nonvoting common stock (subject to adjustments), as more fully described in the Series A Preferred Stock Designation. CapGen LP, CapGen LLC and Mr. Ludwig disclaim their status as directors by deputization by virtue of Messrs. John Rose's and John Sullivan's positions as members of the board of directors of the Issuer. /s/ Eugene A. Ludwig as the managing member of CAPGEN CAPITAL GROUP IV LLC, the general partner of CAPGEN CAPITAL GROUP IV LP 2013-01-03 /s/ Eugene A. Ludwig 2013-01-03