Initial Statement of Beneficial Ownership (3)
07 Abril 2023 - 3:08PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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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1. Name and Address of Reporting Person
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DeBord Matthew J |
2. Date of Event Requiring Statement (MM/DD/YYYY)
4/3/2023
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3. Issuer Name and Ticker or Trading Symbol
TIMBERLAND BANCORP INC [TSBK]
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(Last)
(First)
(Middle)
624 SIMPSON AVENUE |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Chief Lending Officer/EVP / |
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(Street)
HOQUIAM, WA 98550
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4) | 2. Amount of Securities Beneficially Owned
(Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) | 4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Common Stock, $0.01 par value per share | 600 | D | |
| Common Stock, $0.01 par value per share | 2069 | I | By KSOP (1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) | 6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Stock Options (right to buy) (2) | 9/23/2018 | 9/23/2027 | Common Stock, $0.01 par value per share | 2000 | $29.69 | D | |
| Stock options (right to buy) (3) | 9/25/2019 | 9/25/2028 | Common Stock, $0.01 par value per share | 1600 | $31.8 | D | |
| Stock options (right to buy) (4) | 9/24/2020 | 9/24/2029 | Common Stock, $0.01 par value per share | 1400 | $27.14 | D | |
| Stock options (right to buy) (5) | 9/22/2021 | 9/22/2030 | Common Stock, $0.01 par value per share | 1200 | $16.87 | D | |
| Stock options (right to buy) (6) | 9/28/2022 | 9/28/2031 | Common Stock, $0.01 par value per share | 2000 | $28.23 | D | |
| Stock options (right to buy) (7) | 9/27/2023 | 9/27/2032 | Common Stock, $0.01 par value per share | 2000 | $27.4 | D | |
| Explanation of Responses: |
| (1) | Represents shares held in the Timberland Bank Employee Stock Ownership and 40l(k) Plan ("KSOP"). |
| (2) | Stock options were granted on 9/23/2017. These options vested at 20% per annum. |
| (3) | Stock options were granted on 9/25/2018. These options vest at 20% per annum. |
| (4) | Stock options were granted on 9/24/2019. These options vest at 20% per annum. |
| (5) | Stock options were granted on 9/22/2020. These options vest at 20% per annum. |
| (6) | Stock options were granted on 9/28/2021. These options vest at 20% per annum. |
| (7) | Stock options were granted on 9/27/2022. These options will vest at 20% per annum. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
DeBord Matthew J
624 SIMPSON AVENUE
HOQUIAM, WA 98550 |
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| Chief Lending Officer/EVP |
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Signatures
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| /s/Cheryl Parks, Power of Attorney for Matthew J. DeBord | | 4/7/2023 |
| **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 5(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 control number. |
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