SEC FORM
4
SEC Form 4
| 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
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| OMB Number: |
3235-0287 |
| Estimated average burden |
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0.5 |
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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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Southern States Bancshares, Inc.
[ SSBK ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year)
02/09/2022
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One 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 (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
Amount |
(A) or (D) |
Price |
| Common Stock, par value $5.00 per share |
02/09/2022 |
|
A |
|
486
|
A |
$0.00
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9,588 |
D |
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| Common Stock, par value $5.00 per share |
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|
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|
|
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20,000 |
I |
By MLPF&S Inc Cust Davie Investments LTD
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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 Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
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| Remarks: |
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/s/ Robert T. Davie, by Jeff Shanks as Attorney-in-Fact |
02/11/2022 |
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** 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. |
POWER OF ATTORNEY
Know all by these presents, that the undersigned (the "Reporting Person") hereby
constitutes and appoints each of LYNN JOYCE, JEFF WINDHAM, JEFF SHANKS, MICHAEL
D. WATERS, CLINTON H. SMITH, CARLEY TATMAN AND JENESE BECKSTROM, or any of them
acting individually, and with full power of substitution and re-substitution,
the undersigned's true and lawful attorney in fact (each of such persons and
their substitutes being referred to herein as the "Attorney-in-Fact"), with full
power to act for the Reporting Person and in the Reporting Person's name, place
and stead, in any and all capacities, to:
1. Prepare, execute, and submit to the Securities and Exchange Commission
("SEC") a Form ID, including amendments thereto, and any other documents
necessary or appropriate to obtain or renew codes and passwords enabling the
Reporting Person to make electronic filings with the SEC of reports required or
considered by the Attorney-in-Fact to be advisable under Section 13 or Section
16 of the Securities Exchange Act of 1934 (the "Exchange Act") or any rule or
regulation of the SEC;
2. Prepare, execute, and submit to the SEC, Southern States Bancshares,
Inc. (the "Company"), and/or any national securities exchange on which the
Company's securities are listed any and all reports (including any amendments
thereto) the Reporting Person is required to file with the SEC, or which the
Attorney-in-Fact considers it advisable to file with the SEC, under Section 13
or Section 16 of the Exchange Act or any rule or regulation thereunder, or under
Rule 144 under the Securities Act of 1933 ("Rule 144"), with respect to any
security of the Company, including Forms 3, 4 and 5, Schedules 13D and 13G, and
Forms 144; and
3. 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,
and in the best interest of, or legally required by, the Reporting Person, it
being understood that the documents executed by such Attorney-in-Fact on behalf
of the undersigned pursuant to this Power of Attorney shall be in such form and
shall contain such items and conditions as such Attorney-in-Fact may approve in
such Attorney-in-Fact's discretion.
The Reporting Person hereby grants to the Attorney-in-Fact full power and
authority to do and perform each and every act and thing requisite, necessary or
advisable to be done in connection with the foregoing, as fully, to all intents
and purposes, as the undersigned might or could do in person, hereby ratifying
and confirming all that the Attorney-in-Fact, or his or her substitute or
substitutes, shall lawfully do or cause to be done by authority of this Power of
Attorney. The Reporting Person acknowledges that the foregoing
Attorneys-in-Fact, in serving in such capacity at the request of the Reporting
Person, are not assuming, nor is the Company assuming, any of the Reporting
Person's responsibilities to comply with Sections 13 or 16 of the Exchange Act
of 1934 or Rule 144.
This Power of Attorney shall remain in full force and effect until the Reporting
Person is no longer required to file Forms 3, 4, 5, Schedules 13D and 13G, or
Form 144 with respect to the Reporting Person's holdings of and transactions in
securities issued by the Company, unless earlier revoked by the Reporting Person
in a signed writing delivered to the foregoing Attorneys-in-Fact.
Date: July 14, 2021 /s/ Robert T. Davie
Robert T. Davie
