UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Lorenson Katie A 102 S. CLINTON STREET P.O. BOX 1700 IOWA CITY, IA 52244-1700 |
 |  |  SVP, CFO & Treasurer |  |
Kenneth R. Urmie, under Power of Attorney dated July 21, 2016 | 09/02/2016 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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 reporting person's direct share ownership is comprised of three components: 1) 150 shares registered jointly with the reporting person's spouse, 2) 450 unissued shares remaining from a grant of 600 restricted stock units which vest in four equal annual installments of which the first installment vested May 15, 2016, and 3) 1,500 unissued shares acquired pursuant to a grant of restricted stock units which vest in four equal annual installments beginning February 15, 2017. |
(2) | Shares held in the MidWestOne Financial Group, Inc. Employee Stock Ownership Plan as of September 1, 2016. |