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Filing Details

Accession Number:: 0001140361-13-000896
Form Type:: 4
Zero Holdings:: No
Publication Time:: 2013-01-03 21:20:09
Reporting Period:: 2012-09-27

Filing Date:: 2013-01-03
Accepted Time:: 2013-01-03 21:20:09
SEC Url:: Form 4 Filing

Issuer

Cik	Name	Symbol	Sector (SIC)	IRS No
1071264	Jacksonville Bancorp Inc	JAXB	State Commercial Banks (6022)	593472981

Insiders

Cik	Name	Reported Address	Insider Title	Director	Officer	Large Shareholder	Other
1091449	W John Rose	100 North Laura Street Suite 100 Jacksonville FL 32202		Yes	No	Yes	No

Reported Non-Derivative Transactions

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Sec. Name	Acquisiton - Disposition	Date	Amount	Price	Remaning Holdings	Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
Series B Preferred Stock	Acquisiton	2012-09-27	5,000	$1,000.00	5,000	No	4	P	Indirect	Held by CapGen Capital Group IV LP
Series B Preferred Stock	Disposition	2012-12-31	5,000	$0.00	0	No	4	S	Indirect	Held by CapGen Capital Group IV LP
Series A Mandatorily Convertible Preferred Stock	Acquisiton	2012-12-31	5,000	$5,000,000.00	5,000	No	4	P	Indirect	Held by CapGen Capital Group IV LP
Series A Mandatorily Convertible Preferred Stock	Acquisiton	2012-12-31	22,530	$22,530,000.00	22,530	No	4	P	Indirect	Held by CapGen Capital Group IV LP
Series A Mandatorily Convertible Preferred Stock	Acquisiton	2012-12-31	900	$900,000.00	900	No	4	P	Direct
Series A Mandatorily Convertible Preferred Stock	Acquisiton	2012-12-31	100	$100,000.00	100	No	4	P	Indirect	Held by Spouse

Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
No	4	P	Indirect	Held by CapGen Capital Group IV LP
No	4	S	Indirect	Held by CapGen Capital Group IV LP
No	4	P	Indirect	Held by CapGen Capital Group IV LP
No	4	P	Indirect	Held by CapGen Capital Group IV LP
No	4	P	Direct
No	4	P	Indirect	Held by Spouse

Footnotes

CapGen Capital Group IV LP ("CapGen LP") acquired the shares of Noncumulative, Nonvoting Perpetual Preferred Stock, Series B (the "Series B Preferred Stock") of Jacksonville Bancorp, Inc. (the "Issuer") reported in this row on September 27, 2012. CapGen Capital Group IV LLC ("CapGen LLC") is the sole general partner of CapGen LP.
The shares reported in this row were (in the case of disposition) or are (in the case of acquisition) owned directly by CapGen LP. As a principal member and member of the investment committee of CapGen LLC, the sole general partner of CapGen LP, Mr. Rose may be deemed to be the indirect beneficial owner of such shares under Rule 16a-1(c)(2) promulgated under the Securities Exchange Act of 1934, as amended (the "Exchange Act"). Mr. Rose disclaims that he is the beneficial owner of such shares, except to the extent of his pecuniary interest.
Upon receipt of regulatory approval, the Series B Preferred Stock became exchangeable, on a one-for-one basis, into shares of Series A Mandatorily Convertible Preferred Stock ("Series A Preferred Stock"). On December 31, 2012, the 5,000 shares of Series B Preferred Stock were exchanged into 5,000 shares of Series A Preferred Stock.
Of these shares, 100 shares are held in Mr. Rose's retirement account, which is self-directed by Mr. Rose, and 450 of these shares are held jointly with Mr. Rose's wife, Cheryl H. Rose.
The shares reported in this row are held in the retirement account of Mr. Rose's wife, Cheryl H. Rose, which is self-directed by Mrs. Rose. Mr. Rose disclaims that he is the beneficial owner of such shares, except to the extent of his pecuniary interest.
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.