| FORM
4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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
|
| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
|
Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue.
See
Instruction 1(b).
|
1. Name and Address of Reporting Person
*
| C/O GUARANTY BANCSHARES, INC. |
| 201 SOUTH JEFFERSON AVE |
(Street)
|
2. Issuer Name
and
Ticker or Trading Symbol
GUARANTY BANCSHARES INC /TX/
[
GNTY
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| President |
|
3. Date of Earliest Transaction
(Month/Day/Year)
12/06/2021
|
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 Following Reported
Transaction(s) (Instr.
3 and 4)
|
6.
Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
|
7.
Nature of Indirect Beneficial Ownership (Instr.
4)
|
| Code |
V |
Amount |
(A) or (D) |
Price |
|
Common Stock
|
12/06/2021 |
|
M |
|
23,100
|
A
|
$
21.8182
|
99,000
|
D
|
|
|
Common Stock
|
|
|
|
|
|
|
|
113,867
|
I
|
By Issuer KSOP
|
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)
|
| Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
|
Stock Option (right to buy)
|
$
21.8182
|
12/06/2021 |
|
M |
|
|
23,100
|
|
10/15/2024 |
Common Stock
|
23,100
|
|
6,900
|
D
|
|
| Explanation of Responses: |
|
|
|
/s/ Shalene A. Jacobson, as attorney-in-fact |
12/08/2021 |
|
** 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. |
LIMITED POWER OF ATTORNEY
The undersigned, Kirk L. Lee, an officer of Guaranty Bancshares, Inc. (the
"Corporation"), hereby authorizes and designates each of Shalene Jacobson; Tyson
T. Abston; Clifton A. Payne; Derek W. McGee; Kevin E. Strachan and Fenimore,
Kay, Harrison and Ford, LLP, as my agent and attorney-in-fact, each with full
power of substitution to:
(1) prepare and sign on my behalf any Form ID for filing with the United States
Securities and Exchange Commission, generate or update on my behalf any
applicable EDGAR access codes, and request on my behalf any EDGAR passphrases or
other related filings codes, if necessary;
(2) prepare and sign on my behalf any Form 3, Form 4 or Form 5 under Section 16
of the Securities Exchange Act of 1934 or any amendment thereto and file, or
cause to be filed, the same with the United States Securities and Exchange
Commission and, if applicable, each national stock exchange on which the
Corporation's stock is listed;
(3) prepare and sign on my behalf any Form 144 Notice under the Securities Act
of 1933, or any amendment thereto, and file, or cause to be filed, the same with
the United States Securities and Exchange Commission;
(4) prepare and sign on my behalf any Schedule 13D or Schedule 13G under the
Securities Exchange Act of 1934, or any amendment thereto, and file, or cause to
be filed, the same with the United States Securities and Exchange Commission
and, if applicable, each national stock exchange on which the Corporation's
stock is listed; and
(5) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on my behalf
pursuant to this Limited Power of Attorney shall be in such a form and shall
contain such terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary or proper to be done in the exercise of any of the rights and powers
herein granted, as present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Limited Power of Attorney and the rights and powers
herein granted. The undersigned acknowledges that the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, are not assuming, nor is the Corporation assuming, any of the
undersigned's responsibilities to comply with Section 16 of the Securities
Exchange Act of 1934.
This Limited Power of Attorney shall remain in full force and effect until the
undersigned is no longer subject to Section 16 of the Securities Exchange Act of
1934 with respect to the Corporation, unless earlier revoked by the undersigned
in a signed writing delivered to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Limited Power of Attorney to
be executed on this 4th day of October, 2021.
/s/ Kirk L. Lee
____________________________
Kirk L. Lee
SUBSCRIBED AND SWORN TO before me this 4th day of October, 2021.
/s/ Christine Restivo Barnett
____________________________
Notary Public
My Commission Expires: August 03, 2022
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