SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
SCHWARTZ GARY W

(Last) (First) (Middle)
1600 ROYAL STREET

(Street)
JASPER IN 47549

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/19/2004
3. Issuer Name and Ticker or Trading Symbol
KIMBALL INTERNATIONAL INC [ KBALB ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EXECUTIVE VICE PRESIDENT
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
CLASS B COMMON 8,437 D
CLASS B COMMON 2,577 I RETIREMENT FUND
CLASS B COMMON 1,000(1) I WIFE
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
CLASS A COMMON (2) (2) CLASS B COMMON 4,000 (3) D
EMPLOYEE STOCK OPTION (Right to Buy) (4) 08/16/2008 CLASS B COMMON 9,000 $18.24 D
EMPLOYEE STOCK OPTION (Right to Buy) (5) 08/17/2009 CLASS B COMMON 9,000 $19.81 D
EMPLOYEE STOCK OPTION (Right to Buy) 08/23/2002 08/22/2010 CLASS B COMMON 16,500 $16.17 D
EMPLOYEE STOCK OPTION (Right to Buy) 08/22/2003 08/21/2011 CLASS B COMMON 40,000 $15.24 D
EMPLOYEE STOCK OPTION (Right to Buy) 11/15/2007 11/14/2012 CLASS B COMMON 30,000 $15.06 D
RESTRICTED STOCK UNITS (6) (7) CLASS A COMMON 13,400 (8) D
Explanation of Responses:
1. Beneficial ownership disclaimed.
2. Not applicable.
3. Class A Common Stock is convertible to Class B Common Stock on a one-for-one share basis.
4. 389 shares exercisable on 8/17/2000; 5,482 shares exercisable on 1/15/2001; and 3,129 shares exercisable on 1/15/2002.
5. 2,166 shares exercisable on 1/15/2002; 5,047 shares exercisable on 1/15/2003; and 1,787 shares exercisable on 1/15/2004.
6. The Restricted Stock Units vest on 1/23/2009 or (at the election of the reporting person) on the first, second, third, fourth or fifth anniversary of the vest date.
7. The Restricted Stock Units expire if the reporting person ceases employment for any reason other than death, retirement or permanent disability.
8. The Restricted Stock Units convert on a one-for-one basis into shares of Class A Common Stock.
Remarks:
GARY W. SCHWARTZ 10/20/2004
** Signature of Reporting Person Date
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 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.