5 1 newhas5.htm JACK G. HASELBUSH JANUARY 2002 FORM 5 Prepared by Kilpatrick Stockton LLP EDGAR Services/ihj

Form 5

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

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(f) of the Investment Company Act of 1940

OMB APPROVAL

OMB Number: 3235-0287

Expires: PENDING

[   ]

Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See instructions 1(b).

Estimated average burden
hours per response. . . 0.5

[   ]

Form 3 Holdings Reported

  

[   ]

Form 4 Holdings Reported

  

(Print or Type Responses)

1. Name and Address of Reporting Person*

Haselbush, Jack

2. Issuer Name and Ticker or Trading Symbol

Vail Banks, Inc. (VAIL)

6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_X_ Director                    ___ 10% Owner
___ Officer (give             ___ Other (specify
                  title below)                     below)

_____________

(Last)              (First)             (Middle)

5637 Taylor Lane

3. I.R.S. Identification Number of Reporting Person, if an entity voluntary)

4. Statement for Month/Year

2001

(Street)

Fort Collins, CO  80528

5. If Amendment, Date of Original (Month/Year)

7. Individual or Joint/Group Filing
(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person

(City)              (State)              (Zip)

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security
(Instr. 3)

2. Transaction Date
(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 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

Common Stock

7/23/01

J

226,650

D

   

 I

 (1)

Common Stock

12/31/01

G

1,315

D

 

 

  

 

 

 12/31/01

 G

 1,000

 D

 

  136,163

 D

 (2)

 

 

 

 

 

 

  20,275

 I

 (3)

 

(Over)


 

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. Conversion or
Exercise
Price of
Derivative
Security

3. Transaction
Date
(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 at
End of
Month
(Instr. 4)

10. Ownership
Form of
Derivative
Security:
Direct (D) or Indirect (I)
(Instr. 4)

11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

(A)

(D)

Date
Exercisable

Expiration
Date

Title

Amount
or
Number
of Shares

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explanation of Responses:

(1)   In prior reports,  Mr. Haselbush reported indirect ownership of the 226,650 shares as trustee for the United Valley Bank Restated Employee Stock Ownership 401(K) Plan and Retirement Trust (“UVB ESOP/401(K)”).  The UVB ESOP/401(K) was terminated as of July 13, 2000.  On July 23, 2001, all of the shares held by the UVB ESOP/401(K) were distributed to the individual participants, including Mr. Haselbush.
(2)   Includes 97,160 shares received as a distribution from the UVB ESOP/401(K), of which Mr. Haselbush was a participant.
(3)   Held by Mr. Haselbush indirectly as a General Partner of Haselbush Enterprises, LLLP.


**

Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C 78ff(a).

 /s/ Jack G. Haselbush


Jack G. Haselbush
**Signature of Reporting Person

   2/12/02


Date

Note:

File three copies of this Form, one of which must be manually signed.
If space 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.

Page 2
SEC1464 (7-96)