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UNITED STATES
SECURITIES AND EXCHANGE
COMMISSION
Washington, DC 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
| o | Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b) |
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| 1. | Name and Address of
Reporting Person* (Last, First, Middle) |
2. | Issuer Name and Ticker
or Trading Symbol |
3. | I.R.S. Identification
Number of Reporting Person, if an entity (Voluntary) | |||||||
| Mercord, F. Charles
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Glacier Bancorp, Inc. (GBCI)
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49 Commons Loop |
4. | Statement for (Month/Day/Year) | 5. | If Amendment, Date of Original (Month/Day/Year) | ||||||||
| January 2003
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| (Street) | 6. | Relationship of Reporting Person(s) to Issuer (Check All Applicable) | 7. | Individual or Joint/Group
Filing (Check Applicable Line) | ||||||||
| Kalispell, MT 59901
(City) (State) (Zip) |
x | Director | o | 10% Owner | x | Form filed by One Reporting Person | ||||||
| o | Officer (give title below) | o | Form filed by More than One Reporting Person | |||||||||
| o | Other (specify below) | |||||||||||
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| 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). | |
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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) |
2. | Transaction
Date (Month/Day/Year) |
2a. | Deemed Execution Date, if any. (Month/Day/Year) |
3. | Transaction Code (Instr. 8) |
4. | Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. | Amount of Securities Beneficially Owned Following Reported Transactions(s) (Instr. 3 and 4) |
6. | Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. | Nature
of Indirect Beneficial Ownership (Instr. 4) | |||||||||
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| Code | V | Amount | (A) or (D) |
Price | ||||||||||||||||||||
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| Common Stock | 22,264 | D | ||||||||||||||||||||||
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| Common Stock | 8,617 | I | IRA 1 | |||||||||||||||||||||
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| Common Stock | 105,614 | I | IRA 2 | |||||||||||||||||||||
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| Common Stock | 5,896 | I | Wife's IRA | |||||||||||||||||||||
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| Common Stock | 16,357 | I | Wife | |||||||||||||||||||||
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| Common Stock | 587 | I | Family Partnership | |||||||||||||||||||||
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Page 2
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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) |
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) | |||||||
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| Code | V | (A) | (D) | |||||||||||||||
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| Option | 21.08 | |||||||||||||||||
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| Option | 24.35 | |||||||||||||||||
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Page 3
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| Table II — Derivative
Securities Acquired, Disposed of, or Beneficially Owned —
Continued (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||||
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| 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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| Date Exercisable |
Expiration Date |
Title | Amount or Number of Shares |
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| 12-31-99 | 06-30-04 | Common Stock | 2,200 | 2,200 | D | ||||||||||||
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| 07-29-03 | 01-29-08 | Common Stock | 1,500 | 1,500 | D | ||||||||||||
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Explanation of Responses:
| /s/ James H. Strosahl signing on behalf of F. Charles Mercord | February 5, 2003 | |
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**Signature of Reporting Person |
Date |
| ** | 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. | |
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