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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 | ||||||||
Stock Option | $ 16.86 | (1) | 12/31/2012 | Common Stock | 6,650 | 6,650 | D | ||||||||
Stock Option | $ 19.75 | (1) | 12/31/2013 | Common Stock | 6,982 | 6,982 | D | ||||||||
Stock Option | $ 21.94 | (1) | 04/21/2014(3) | Common Stock | 6,649 | 6,649 | D | ||||||||
Stock Option | $ 18.71 | (1) | 04/21/2014(4) | Common Stock | 2,849 | 2,849 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HOWARD CHARLES S 102 SOUTH CLINTON STREET IOWA CITY, IA 52240 |
X |
Kenneth R. Urmie, under Power of Attorney dated January 22, 2009 | 04/22/2011 | |
**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) | Fully vested. |
(2) | Shares held in MidWestOne Financial Group, Inc. Employee Stock Ownership Plan and allocated to reporting person's account as of April 21, 2011. Reporting person's ownership of shares in his ESOP account increased since his last report due to allocations made to his account. |
(3) | Expiration date changed from 12/31/2014 to 4/21/2014 to comply with retirement provisions of 1998 Stock Option Plan as an employee stock option upon termination of reporting person's paid employment status on 4/21/2011. |
(4) | Expiration date changed from 12/31/2015 to 4/21/2014 to comply with retirement provisions of 1998 Stock Option Plan as an employee stock option upon termination of reporting person's paid employment status on 4/21/2011. |
(5) | Shares were acquired pursuant to a grant of restricted stock units which vest in four equal annual installments beginning April 22, 2012. |