FORM 5
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 |
OMB APPROVAL
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[ ] Check box if no longer subject | OMB Number: 3235-0362 | |
to Section 16. Form 4 or Form | ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP | Expires: January 31, 2005 |
5 obligations may continue. See Instruction 1(b) | Estimated average burden hours per response....................1.0 | |
[ ] Form 3 Holdings Reported | ||
[ ] From 4 Transactions Reported | Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility |
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Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 |
1. Name and Address of Reporting Person* Larsen, Michael K. |
2. Issuer Name and Ticker or Trading Symbol Banner Corporation "BANR " |
6. Relationship of Reporting Person(s) to Issuer (Check all applicable)
Director 10% Owner |
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(Last) (First) (Middle)
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3. IRS Identification
Number of Reporting
Person, if an entity (voluntary) |
4. Statement for Month/Year 12/02 |
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(Street)
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5. If Amendment, Date of Original
(Month/Year)
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7. Individual or Joint/Group Reporting | ||||||||
(City) (State) (Zip) |
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1. Title of Security (Instr. 3) | 2. Trans-action 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 Bene-ficially Owned at End of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Owner-ship Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Amount | (A) or (D) | Price | ||||||||
*If the form is filed by more than one reporting person, see
Instruction 4(b)(v).
SEC 1474 (3-99)
Potential persons who are to respond to
the collection of information contained in this form are not required
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FORM 5 (continued) Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) | 2. Con-version or Exercise Price of Derivative Security | 3. Trans-action Date (Month/ Day/Year) | 3A. Deemed Execution Date, if any (Month/ Day/Year) |
4. Trans-action 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 Sec-urities (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of Deriva-tive Se-curities Benefici- ally Owned at End of Year (Instr. 4) | 10. Owner-ship of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4 ) | |||
(A) | (D) | Date Exer-cisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Phantom Stock Units | 1 for 1 | 2/04/02 | A | .69 | * | * | Common Stock | .69 | 18.25 | D | ||||
Phantom Stock Units | 1 for 1 | 2/15/02 | A | 74.4 | * | * | Common Stock | 74.4 | 20.57 | D | ||||
Phantom Stock Units | 1 for 1 | 5/15/02 | A | 8.48 | * | * | Common Stock | 8.48 | 24.23 | D | ||||
Phantom Stock Units | 1 for 1 | 8/14/02 | A | 8.93 | * | * | Common Stock | 8.93 | 21.42 | 1,314 | D | |||
Explanation of Responses:
*Phantom Stock Units acquired pursuant to deferred compensation agreement; settled in stock at termination of service.
/s/Michael
K. Larsen 1/14/03
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. ** Signature of Reporting Person Date
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 provided is insufficient, see Instruction 6 for procedure
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
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