INTERMOUNTAIN COMMUNITY BANCORP - FORM S-1/A - EX-99.4 - FORM OF NOMINEE HOLDER CERTIFICATION - April 13, 2012

Attached files

file filename
S-1/A - AMENDMENT NO. 1 TO FORM S-1 - INTERMOUNTAIN COMMUNITY BANCORPd304273ds1a.htm
EX-4.7 - FORM OF SUBSCRIPTION RIGHTS CERTIFICATE - INTERMOUNTAIN COMMUNITY BANCORPd304273dex47.htm
EX-5.1 - OPINION OF GRAHAM & DUNN PC - INTERMOUNTAIN COMMUNITY BANCORPd304273dex51.htm
EX-23.1 - CONSENT OF BDO USA, LLP - INTERMOUNTAIN COMMUNITY BANCORPd304273dex231.htm
EX-99.5 - FORM OF BENIFICIAL OWNER ELECTION FORM - INTERMOUNTAIN COMMUNITY BANCORPd304273dex995.htm
EX-99.3 - FORM OF LETTER TO SHAREHOLDERS - INTERMOUNTAIN COMMUNITY BANCORPd304273dex993.htm
EX-99.2 - FORM OF LETTER TO CLIENTS - INTERMOUNTAIN COMMUNITY BANCORPd304273dex992.htm
EX-99.9 - FORM OF SUBSCRIPTION AGENT AGREEMENT - INTERMOUNTAIN COMMUNITY BANCORPd304273dex999.htm
EX-99.8 - FORM OF GUARANTEED DELIVERY - INTERMOUNTAIN COMMUNITY BANCORPd304273dex998.htm
EX-99.1 - FORM OF INSTRUCTIONS AS TO USE OF RIGHTS CERTIFICATE - INTERMOUNTAIN COMMUNITY BANCORPd304273dex991.htm
EX-99.6 - FORM OF NOTICE OF IMPORTANT TAX INFORMATION - INTERMOUNTAIN COMMUNITY BANCORPd304273dex996.htm
EX-99.7 - FORM OF LETTER TO BROKERS AND OTHER NOMINEE HOLDERS - INTERMOUNTAIN COMMUNITY BANCORPd304273dex997.htm

Exhibit 99.4

INTERMOUNTAIN COMMUNITY BANCORP

NOMINEE HOLDER CERTIFICATION

The undersigned, a broker, custodian bank, trustee, depositary or other nominee holder of rights (the “Rights”) to purchase shares of common stock (“Common Stock”) of Intermountain Community Bancorp (the “Company”) pursuant to the rights offering described and provided for in the Company’s registration statement, as amended, and final prospectus dated                     , 2012 (the “Prospectus”), hereby certifies to the Company, American Stock Transfer & Trust Company, LLC as subscription agent for the Rights Offering, that (1) the undersigned has exercised, on behalf of the beneficial owners thereof (which may include the undersigned), the number of Rights specified below pursuant to the basic subscription right (as defined in the Prospectus), and on behalf of beneficial owners of Rights who have subscribed for the purchase of additional shares of Common Stock pursuant to the over-subscription privilege (as defined in the Prospectus), listing separately below each such exercised basic subscription right and the corresponding over-subscription privilege (without identifying any such beneficial owner), and (2) each such beneficial owner’s basic subscription right has been exercised in full:

 

Number of Shares of Common

Stock Owned on the Record Date

    Rights Exercised Pursuant to
Basic Subscription Right		    Number of Shares Subscribed
For Pursuant to Over-
Subscription Privilege
     
     
     
     
     
     
     
     
     
     

 

Provide the following information if applicable:

   
    

Depository Trust Company (“DTC”)

   

Participant Number

   

Participant Name:                                                               

   

 

By:      
  Name:                                                                   
  Title:                                                                    

DTC Basic Subscription Confirmation Number(s)

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