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FORM 4
- ------ U.S. SECURITIES AND EXCHANGE COMMISSION
[ ] Check box if no longer WASHINGTON, DC 20549
subject to Section 16. Form
4 or Form 5 obligations may STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
continue. See Instruction 1(b).
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility
Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person(1)|2. Issuer Name and Ticker or Trading Symbol |6. Relationship of Reporting Person
| | to Issuer (Check all applicable)
Ohlhausen George M. | Success Bancshares, Inc. (SXNB) | X Director 10% Owner
- -------------------------------------------------------------------------------------------| ----- -----
(Last) (First) (Middle) |3. IRS Identification | 4. Statement for | Officer (give title below)
| Number of | Month/Year | -----
| Reporting Person, | | Other (specify below)
c/o Success Bancshares, Inc. | if an Entity | 8/99 | -----
One Marriott Drive | (Voluntary) | |
- -----------------------------------------| |-------------------------|----------------------------------------
(Street) | | 5. If Amendment, |7. Individual or Joint/Group Filing
| | Date of Original | (Check applicable line)
Lincolnshire, IL 60069 | | (Month/Year) | X
| | | -- Form Filed by One Reporting Person
- -----------------------------------------|-------------------------------------------------| -- Form Filed by More than One
(City) (State) (Zip) | | Reporting Person
| |
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TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security |2. Transaction| 3. Transaction|4. Securities Acquired (A)| 5. Amount of|6. Owner- |7. Nature
(Instr. 3) | Date | Code | or Disposed of (D) | Securities | ship | of
| | (Instr. 8) | (Instr. 3, 4 and 5) | Beneficially| Form: | Indirect
| | | | Owned at End| Direct | Bene-
| |---------------|--------------------------| of Month | (D) or | ficial
| | | | | (A) | | (Instr. 3 | Indirect | Owner-
| (Month/Day/ | | | | or | | and 4) | (I) | ship
| Year) | Code | V | Amount | (D) | Price | |(Instr. 4)|(Instr. 4)
- --------------------------------------|--------------|-------|-------|--------|------|----------|-------------|--------- |---------
Common Stock | | | | | | | 28,014 | D |
- --------------------------------------|--------------|-------|-------|--------|------|----------|-------------|--------- |---------
Common Stock | | | | | | | 108,485 | I | (1)
- --------------------------------------|--------------|-------|-------|--------|------|----------|-------------|--------- |---------
Common Stock | | | | | | | 68,000 | I | (2)
- --------------------------------------|--------------|-------|-------|--------|------|----------|-------------|--------- |---------
Common Stock | | | | | | | 44,387 | I | (3)
- --------------------------------------|--------------|-------|-------|--------|------|----------|-------------|--------- |---------
| | | | | | | | |
- --------------------------------------|--------------|-------|-------|--------|------|----------|-------------|--------- |---------
| | | | | | | | |
- --------------------------------------------------------------------------------------------------------------|--------- |---------
(1) By the George M. Ohlhausen Trust as Trustee for Sarah Ohlhausen
(2) By the Sarah Ohlhausen Trust as Trustee for George M. Ohlhausen
(3) By the George M. Ohlhausen IRA | |
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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).
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FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative | 2. Conver- |3. Trans- |4. Trans- |5. Number of |6. Date Exer- |7. Title and Amount |8. Price
Security | sion or | action | action | Derivative | cisable and | of Underlying | of
(Instr. 3) | Exercise | Date | Code | Securities Ac- | Expiration | Securities | Deriv-
| Price of | (Month/ | (Instr. 8)| quired (A) or | Date | (Instr. 3 and 4) | ative
| Deriv- | Day/ | | Disposed of (D)| (Month/Day/ | | Secur-
| ative | Year) | | (Instr. 3, 4, | Year) | | ity
| Security | | | and 5) | | | (Instr. 5)
| | | | |-------------------------------------|
| | | | |Date |Expira- | | Amount or |
| | |-------------------------------|Exer- |tion | Title | Number of |
| | | Code |V | (A) |(D) |cisable|Date | | Shares |
- ------------------------|-------------|----------|-------|----|--------|---------|-------|--------|--------|-----------|------------
Stock Options | | | | | | |8/26/99|8/26/08 |Common | 5,000 | $14.50
| | | | | | | | |Stock | |
- ------------------------|-------------|----------|-------|----|--------|---------|-------|--------|--------|-----------|------------
Stock Options | $10.75 | 8/25/99 | A | V | 3,000 | N/A |8/25/00|8/25/09 |Common | 3,000 | $10.75
| | | | | | | | |Stock | |
- ------------------------|-------------|----------|-------|----|--------|---------|-------|--------|--------|-----------|------------
| | | | | | | | | | |
- ------------------------|-------------|----------|-------|----|--------|---------|-------|--------|--------|-----------|------------
| | | | | | | | | | |
- ------------------------|-------------|----------|-------|----|--------|---------|-------|--------|--------|-----------|------------
| | | | | | | | | | |
- ------------------------|-------------|----------|-------|----|--------|---------|-------|--------|--------|-----------|------------
| | | | | | | | | | |
- ------------------------|-------------|----------|-------|----|--------|---------|-------|--------|--------|-----------|------------
| | | | | | | | | | |
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9. Number of | 10. Ownership | 11. Nature of
Derivative | Form of | Indirect
Securities | Derivative | Beneficial
Beneficially | Security: | Ownership
Owned at End | Direct (D) | (Instr. 4)
of Month | or Indirect (I) |
(Instr. 4) | (Instr. 4) |
- ------------------|------------------------|------------------------------
5,000 | D | N/A
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3,000 | D | N/A
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| |
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| |
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| |
- ------------------|------------------------|------------------------------
| |
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Explanation of Responses:
/s/ George M. Ohlhausen 10-19-99
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Signature of Reporting Person(1) Date
George M. Ohlhausen
** 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 provided is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collectio of information contained in this form are not
required to respond unless the form displays a currently valid OMB Number.
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(Print or Type Responses)
