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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 | (4) | 04/01/2018 | Common Stock | 500 | 500 | D | ||||||||
Employee Stock Option (Right to Buy) | $ 7.02 | (5) | 07/16/2019 | Common Stock | 1,200 | 1,200 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Evans Susan R 102 S. CLINTON STREET P.O BOX 1700 IOWA CITY, IA 52244-1700 |
Chief Operating Officer |
Kenneth R. Urmie, under Power of Attorney dated July 17, 2009 | 02/26/2016 | |
**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 were acquired pursuant to a grant of restricted stock units which vest in four equal annual installments beginning February 15, 2017. |
(2) | Restricted Stock Units withheld to pay payroll taxes due upon vesting and issuance of Restricted Stock Units shares on February 15, 2016. |
(3) | Shares held in the MidWestOne Financial Group, Inc. Employee Stock Ownership Plan as of February 15, 2016. Shares increased by 18 shares since the date of the reporting person's last filing due to additional shares allocated to the reporting person's ESOP account. |
(4) | The option vests in four equal annual installments beginning on April 1, 2009. |
(5) | The option vests in four equal annual installments beginning on July 16, 2010. |
Remarks: The purpose of this amended Form is to add Footnote 2, to reduce the number of forfeited shares by 117 shares, to 609 shares, and to add the market price per share forfeited. |