-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, FGSkIfnxTl/UfZEcdVssN1ynpWKCTKpuQPyji6GyXqtPU8J1q9lpm5RGEo5nxvUr /A4XiBi2Gb66k8ryMBYQxA== 0000950134-03-000892.txt : 20030122 0000950134-03-000892.hdr.sgml : 20030122 20030122105502 ACCESSION NUMBER: 0000950134-03-000892 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030116 FILED AS OF DATE: 20030122 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SCOTT THOMAS W CENTRAL INDEX KEY: 0001198535 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 MAIL ADDRESS: STREET 1: C/O FIRST INTERSTATE BANCSYSTEM INC STREET 2: P O BOX 30918 CITY: BILLINGS STATE: MT ZIP: 59116 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FIRST INTERSTATE BANCSYSTEM INC CENTRAL INDEX KEY: 0000860413 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 810331430 STATE OF INCORPORATION: MT FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-49733 FILM NUMBER: 03520376 BUSINESS ADDRESS: STREET 1: P O BOX 30918 STREET 2: 401 NO 31ST STREET CITY: BILLINGS STATE: MT ZIP: 59116-0918 BUSINESS PHONE: 4062555300 FORMER COMPANY: FORMER CONFORMED NAME: FIRST INTERSTATE BANCSYSTEM OF MONTANA INC DATE OF NAME CHANGE: 19930615 4 1 c74157tse4.htm FORM 4 First Interstate Bancsystem, Inc.
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

FORM 4

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(h) of the Investment Company Act of 1940

o 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* (Last, First, Middle)		 2. Issuer Name and Ticker or
Trading Symbol		 3. I.R.S. Identification Number of Reporting
Person, if an entity (Voluntary)
  Scott, Thomas W.
  First Interstate BancSystem, Inc. (no ticker or trading symbol)
 
  401 North 31st Street
4. Statement for (Month/Day/Year) 5. If Amendment, Date of Original (Month/Day/Year)
    January 16, 2003
 
  (Street) 6. Relationship of Reporting Person(s) to Issuer (Check All Applicable) 7. Individual or Joint/Group Filing
(Check Applicable Line)
  Billings, MT 59101
(City)                (State)           (Zip)		   x  Director x  10% Owner   x Form filed by One Reporting Person
    x  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
        Chief Executive Officer
     
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).
 

 

 
Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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
Transactions(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   1/16/03 N/A   G V   2,446   D $0.00     705,108     D   N/A
  Common Stock               5,464     I   By 401(k) Plan
  Common Stock               2,152     I   By Spouse
  Common Stock               227,827     I   By Self as Custodian
                     
                     
                     
                   
                   
                   

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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)		 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)
                      Code V   (A) (D)
  Stock Option   $42.00          
  Stock Option   $42.00          
  Stock Option   $42.00          
  Stock Option   $42.00          
  Stock Option(1)   $42.00          
             
             
             
             
             

Page 3

 
Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)
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
Following Reported Transaction(s)
(Instr. 4)		 10. Ownership Form of
Derivative Security:
Direct (D) or Indirect (I)
(Instr. 4)		 11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
  Date
Exercisable		 Expiration
Date		   Title Amount or
Number of
Shares		                        
  2/19/02 3/15/08   Common Stock 3,300         3,300     D  
  2/19/02 3/15/09   Common Stock 10,450         10,450     D  
  2/19/02 3/15/10   Common Stock 9,900         9,900     D  
  2/19/02 3/15/11   Common Stock 9,900         9,900     D  
  2/19/02 3/15/12   Common Stock 7,000         7,000     D  
                 
                 
                 
                 
                 

Explanation of Responses:

(1) Vests - 25% on date of grant and 25% each year for three years

/s/ TERRILL R. MOORE   January 21, 2003
Attorney in Fact for Reporting Person		  
Date

**   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.
 

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