UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 22)*
HAWTHORN BANCSHARES, INC.
(Name of Issuer)
COMMON STOCK - $1.00 PAR VALUE
(Title of Class of Securities)
420476103
(CUSIP Number)
December 31, 2016
(Date of Event which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
¨ Rule 13d-1(b)
¨ Rule 13d-1(c)
¨ Rule 13d-1(d)
* The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
| CUSIP No. 420476103 | 13G | Page 2 of 5 Pages |
| 1. |
NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
HAWTHORN BANK |
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| 2. |
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (see instructions) (a) ¨ (b) ¨ |
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| 3. |
SEC USE ONLY
|
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| 4. |
CITIZENSHIP OR PLACE OF ORGANIZATION
|
| NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH |
5. |
SOLE VOTING POWER
298,175 | ||
| 6. |
SHARED VOTING POWER
0 | |||
| 7. |
SOLE DISPOSITIVE POWER
298,175 | |||
| 8. |
SHARED DISPOSITIVE POWER
258,260 |
| 9. |
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
556,435 |
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| 10. |
CHECK IF THE AGGREGATE AMOUNT IN ROW
(9) EXCLUDES CERTAIN SHARES
|
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| 11. |
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
9.9% |
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| 12. |
TYPE OF REPORTING PERSON (see instructions)
BK |
Page 3 of 5 Pages
ITEM 1:
| (a) | Name of Issuer: Hawthorn Bancshares, Inc. |
| (b) | Address of Issuer's Principal Executive Offices: |
132 East High Street
Jefferson City, Missouri 65101
ITEM 2:
| (a) | Name of Person Filing: This Schedule 13G is filed by the Hawthorn Bank (the "Bank"). |
| (b) | Address of Principal Business Office or, if none, Residence: The business address for the Bank is 132 East High Street, Jefferson City, Missouri 65101. |
| (c) | Citizenship: The Bank is a state, non-member, banking association organized under the laws of the State of Missouri. |
| (d) | Title of Class of Securities: Common stock, par value $1.00 per share. |
| (e) | CUSIP No.: 420476103 |
ITEM 3:
If this statement is filed pursuant to Rules 13d-1 (b), or 13d-2 (b), check whether the person filing is a:
| (a) | x Bank as defined in Section 3 (a) (6) of the Act. Income Security Act |
| ITEM 4: | Ownership (as of December 31, 2016) |
| (a) | Amount beneficially owned: 556,435 shares. |
| (b) | Percent of class: The shares identified in paragraph (a) above as being beneficially owned by the Bank represent 9.9% of the 5,616,607 shares outstanding on December 31, 2016. |
| (c) | Number of shares of which such person has: |
| (i) | sole power to vote or to direct the vote: |
298,175 shares.
Page 4 of 5 Pages
| (ii) | shared power to vote or to direct the vote: 0 shares. |
| (iii) | sole power to dispose or to direct the disposition of: 298,175 shares. |
| (iv) | shared power to dispose or to direct the disposition of: |
258,260 shares.
| ITEM 5: | Ownership of Five Percent or Less of a Class. |
Not applicable.
| ITEM 6: | Ownership of More than Five Percent on Behalf of Another Person. |
Of the shares reported in this Schedule 13G, the 556,435 shares reported in this Schedule 13G are held by the Bank as trustee or co-trustee, personal representative or administrator under various individual trusts and estates that exist for the benefit of the respective beneficiaries identified by the applicable trust or estate documentation, as to which shares the Bank has sole voting power as to 298,175 shares, shared voting power as to 0 shares, sole investment power as to 298,175 shares, and shared investment power as to 258,260 shares.
| ITEM 7: | Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company. |
Not applicable.
| ITEM 8: | Identification and Classification of Members of the Group. |
Not applicable.
| ITEM 9: | Notice of Dissolution of Group. |
Not applicable.
Page 5 of 5 Pages
| ITEM 10: | Certification. |
By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were acquired in the ordinary course of business and were not acquired for the purpose of and do not have the effect of changing or influencing the control of the issuer of such securities and were not acquired in connection with or as a participant in any transaction having such purpose or effect.
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
Dated: February 13, 2017
| HAWTHORN BANK | ||
| By Hawthorn Bank | ||
| BY: | /s/ Daniel A. Renfrow | |
| Daniel A. Renfrow | ||
| Vice President & Sr. Trust Officer | ||