FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
FIRST MIDWEST BANCORP INC [ FMBI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 11/04/2004 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction 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 Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 11/04/2004 | M(1) | 3,459 | A | $10.7734 | 52,733 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | M(2) | 3,233 | A | $12.16 | 55,966 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | M(3) | 2,420 | A | $17.1 | 58,386 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | M(4) | 6,455 | A | $18.4 | 64,841 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | M(5) | 2,785 | A | $18.55 | 67,626 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | M(6) | 2,289 | A | $21.7 | 69,915 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | M(7) | 1,606 | A | $21.8334 | 71,521 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | M(8) | 6,231 | A | $22.5 | 77,752 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | M(9) | 7,652 | A | $28.695 | 85,404 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(1) | 1,042 | D | $0 | 84,362 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(2) | 1,099 | D | $0 | 83,263 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(3) | 1,157 | D | $0 | 82,106 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(4) | 3,320 | D | $0 | 78,786 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(5) | 1,445 | D | $0 | 77,341 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(6) | 1,389 | D | $0 | 75,952 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(7) | 981 | D | $0 | 74,971 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(8) | 3,919 | D | $0 | 71,052 | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 11/04/2004 | F(9) | 6,138 | D | $0 | 64,914(10) | I | By NQ Stock Option Gain Deferral Plan Tr | ||
Common Stock | 31,235(11) | D | ||||||||
Common Stock | 517(12) | I | By Immediate Family | |||||||
Common Stock | 836(13) | I | By Profit Sharing Plan Trust |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Non-Qualified Stock Option (right to buy) | $35.775 | 11/04/2004 | A(15) | 6,138 | 05/04/2005 | 02/20/2012 | Common Stock | 6,138 | $0 | 6,138 | D | ||||
Non-Qualified Stock Option (right to buy) | $10.7734 | 11/04/2004 | M(1) | 3,459 | (14) | 02/15/2005 | Common Stock | 3,459 | $10.7734 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $35.775 | 11/04/2004 | A(15) | 1,042 | 01/15/2005 | 02/15/2005 | Common Stock | 1,042 | $0 | 1,042 | D | ||||
Non-Qualified Stock Option (right to buy) | $12.16 | 11/04/2004 | M(2) | 3,233 | (16) | 02/21/2006 | Common Stock | 3,233 | $12.16 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $35.775 | 11/04/2004 | A(15) | 1,099 | 05/04/2005 | 02/21/2006 | Common Stock | 1,099 | $0 | 1,099 | D | ||||
Non-Qualified Stock Option (right to buy) | $17.1 | 11/04/2004 | M(3) | 2,420 | (17) | 02/19/2007 | Common Stock | 2,420 | $17.1 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $35.75 | 11/04/2004 | A(15) | 1,157 | 05/04/2005 | 02/19/2007 | Common Stock | 1,157 | $0 | 1,157 | D | ||||
Non-Qualified Stock Option (right to buy) | $21.7 | 11/04/2004 | M(6) | 2,289 | (18) | 02/18/2008 | Common Stock | 2,289 | $21.7 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $35.775 | 11/04/2004 | A(15) | 1,389 | 05/04/2005 | 02/18/2008 | Common Stock | 1,389 | $0 | 1,389 | D | ||||
Non-Qualified Stock Option (right to buy) | $18.55 | 11/04/2004 | M(5) | 2,785 | (19) | 02/17/2009 | Common Stock | 2,785 | $18.55 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $35.775 | 11/04/2004 | A(15) | 1,445 | 05/04/2005 | 02/17/2009 | Common Stock | 1,445 | $0 | 1,445 | D | ||||
Non-Qualified Stock Option (right to buy) | $21.8334 | 11/04/2004 | M(7) | 1,606 | (20) | 08/18/2009 | Common Stock | 1,606 | $21.8334 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $35.775 | 11/04/2004 | A(15) | 981 | 05/04/2005 | 08/18/2009 | Common Stock | 981 | $0 | 981 | D | ||||
Non-Qualified Stock Option (right to buy) | $18.4 | 11/04/2004 | M(4) | 6,455 | (21) | 02/16/2010 | Common Stock | 6,455 | $18.4 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $35.775 | 11/04/2004 | A(15) | 3,320 | 05/04/2005 | 02/16/2010 | Common Stock | 3,320 | $0 | 3,320 | D | ||||
Non-Qualified Stock Option (right to buy) | $22.5 | 11/04/2004 | M(8) | 6,231 | (22) | 02/21/2011 | Common Stock | 6,231 | $22.5 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $35.775 | 11/04/2004 | A(15) | 3,919 | 05/04/2005 | 02/21/2011 | Common Stock | 3,919 | $0 | 3,919 | D | ||||
Non-Qualified Stock Option (right to buy) | $28.695 | 11/04/2004 | M(9) | 7,652 | (23) | 02/20/2012 | Common Stock | 7,652 | $28.695 | 7,652 | D |
Explanation of Responses: |
1. The transaction represents the exercise of 3,459 stock options under the Omnibus Stock & Incentive Plan whereby 1,042 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 2,417 shares. |
2. The transaction represents the exercise of 3,233 stock options under the Omnibus Stock & Incentive Plan whereby 1,099 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 2,134 shares. |
3. The transaction represents the exercise of 2,420 stock options under the Omnibus Stock & Incentive Plan whereby 1,157 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 1,263 shares. |
4. The transaction represents the exercise of 6,455 stock options under the Omnibus Stock & Incentive Plan whereby 3,320 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 3,135 shares. |
5. The transaction represents the exercise of 2,785 stock options under the Omnibus Stock & Incentive Plan whereby 1,445 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 1,340 shares. |
6. The transaction represents the exercise of 2,289 stock options under the Omnibus Stock & Incentive Plan whereby 1,389 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 900 shares. |
7. The transaction represents the exercise of 1,606 stock options under the Omnibus Stock & Incentive Plan whereby 981 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 625 shares. |
8. The transaction represents the exercise of 6,231 stock options under the Omnibus Stock & Incentive Plan whereby 3,919 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 2,312 shares. |
9. The transaction represents the exercise of 7,652 stock options under the Omnibus Stock & Incentive Plan whereby 6,138 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 1,514 shares. |
10. Between May 27, 2004 and November 8, 2004 the reporting person acquired 615 shares of First Midwest common stock pursuant to the dividend reinvestment feature under the First Midwest Bancorp, Inc. Non-Qualified Gain Deferral Plan. The information in this report is based on a plan statement dated October 19, 2004. |
11. Between May 27, 2004 and November 8, 2004 the reporting person acquired 234 shares of First Midwest common stock under the First Midwest Bancorp, Inc. Dividend Reinvestment Plan. The information in this report is based on a plan statement dated October 19, 2004. |
12. Between May 27, 2004 and November 8, 2004 the reporting person acquired 8 shares of First Midwest common stock under the First Midwest Bancorp, Inc. Dividend Reinvestment Plan. The information in this report is based on a plan statement dated October 19, 2004. |
13. Between May 27, 2004 and November 8, 2004 the reporting person acquired 11 shares of First Midwest common stock pursuant to the dividend reinvestment feature under the First Midwest Bancorp, Inc. Savings and Profit Sharing Plan. The information in this report is based on a plan statement dated October 25, 2004. |
14. The stock option vests in two equal annual installments beginning on February 15, 1997. |
15. The transaction represents a reload stock option granted under the Omnibus Stock & Incentive Plan to replace the number of shares tendered in the option exercised on 11/4/04. |
16. The stock option vests in two equal annual installments beginning on February 21, 1998. |
17. The stock option vests in two equal annual installments beginning on February 19, 1999. |
18. The stock option vests in two equal annual installments beginning on February 18, 2000. |
19. The stock option vests in two equal annual installments beginning on February 17, 2001. |
20. The stock option vests in two equal annual installments beginning on August 18, 2001. |
21. The stock option vests in two equal annual installments beginning on February 16, 2002. |
22. The stock option vests in two equal annual installments beginning on February 21, 2003. |
23. The stock option vests in two equal annual installments beginning on February 20, 2004. |
Remarks: |
By: Andrea L. Stangl, Attorney-in-fact for | 11/08/2004 | |
** 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 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). | ||
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. |