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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 at End of Issuer's Fiscal Year (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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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Stock Option | $ 16.86 | Â | Â | Â | Â | Â | Â (2) | 12/31/2012 | Common Stock | Â | 6,650 | Â | ||
Stock Option | $ 19.75 | Â | Â | Â | Â | Â | Â (2) | 12/31/2013 | Common Stock | Â | 6,982 | Â | ||
Stock Option | $ 21.94 | Â | Â | Â | Â | Â | Â (2) | 04/21/2014 | Common Stock | Â | 6,649 | Â | ||
Stock Option | $ 18.71 | Â | Â | Â | Â | Â | Â (2) | 04/21/2014 | Common Stock | Â | 2,849 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HOWARD CHARLES S 102 S. CLINTON STREET P.O. BOX 1700 IOWA CITY, IA 52244-1700 |
 X |  |  |  |
Kenneth R. Urmie, under Power of Attorney dated January 22, 2009 | 02/03/2012 | |
**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) | Shares held in MidWestOne Financial Group, Inc. Employee Stock Ownership Plan and allocated to the reporting person's account as of December 31, 2011. Reporting person's ownership of shares in his ESOP decreased since his last report due to shares sold as part of a five year plan begun in 2011 to distribute cash to an IRA. Additional distributions are expected to occur in years 2012 through 2015. |
(2) | Fully vested. |