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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
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 | ||||||||
Employee Stock Option (Right To Buy) | $ 16.69 | (1) | 04/01/2018 | Common Stock | 6,000 | 6,000 | D | ||||||||
Employee Stock Option (Right To Buy) | $ 9.34 | (2) | 01/22/2019 | Common Stock | 15,000 | 15,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Funk Charles N 102 SOUTH CLINTON STREET IOWA CITY, IA 52240 |
X | President and CEO |
Kenneth R. Urmie, under Power of Attorney dated January 22, 2009 | 02/16/2010 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The option vests in four equal annual installments beginning on April 1, 2009. |
(2) | The option vests in four equal annual installments beginning on January 22, 2010. |
(3) | Shares held in MidWestOne Financial Group, Inc. Employee Stock Ownership Plan and allocated to reporting person's account as of December 31, 2009. |
(4) | Shares were acquired pursuant to a grant of restricted stock units, of which 50% vest on the 2nd anniversary of the grant and 25% each vest annually on the 3rd and 4th anniversary of the grant. Settlement of shares is subject to MidWestOne Financial Group, Inc. repaying its obligation under the United States Treasury's Troubled Asset Relief Program. The award is further subject to amendment by the company to ensure compliance with the Emergency Economic Stabilization Act of 2008, as amended. |
(5) | On Form 4 filed January 25, 2010 shares were incorrectly coded as Disposed Of. |