5/A 1 x5-klitz.txt UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). ( ) Form 3 Holdings Reported. ( ) Form 4 Transactions Reported. 1. Name and Address of Reporting Person: Klitzing, Steven T. 1391 Forest View Lane Oconomowoc, WI 53066 2. Issuer Name and Ticker or Trading Symbol: CIB Marine Bancshares, Inc. (not listed) 3. IRS or Social Security Number of Reporting Person (Voluntary): 4. Statement for Month/Year: December, 2001 5. If Amendment, Date of Original (Month/Year): December, 2001 6. Relationship of Reporting Person(s) to Issuer (Check all applicable): ( ) Director ( ) 10% Owner (x) Officer (give title below) ( ) Other (specify below) Senior Vice President, Chief Financial Officer, Treasurer and Assistant Secretary 7. 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 ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED 5. Amount of Securities 6. 7. 2. Beneficially Ownership Nature of 1. Transaction 3. 4. Owned at End Form; Direct Indirect Title of Date Transaction Securities Acquired (A) or of Issuer's (D) or Beneficial Security (Month/Day/ Code Disposed of (D) Fiscal Year Indirect (I) Ownership (Instr. 3) Year) (Instr. 8) (Instr. 3, 4 and 5) (Instr. 3 and 4) (Instr. 4) (Instr. 4) ---------- ----------- ----------- ---------------------------- ---------------- ------------ ---------- Code V Amount (A) or (D) Price ---- - ------ ---------- ----- Common Stock 9,750 D Common Stock 8,848.6(1) I By ESOP
Table II - Derivative Securities Acquired, Disposed of, or Benefically Owned (e.g., Puts, Calls, Warrants, Options, Convertible Securities) 9. Number of 10. deriva- Ownership 5. tive Form of 11. Number of Securi- Deriva- Nature Derivative ties tive of 2. Securities 7. 8. Benefi- Security: Indirect Conversion 4. Acquired Title and Price of cially Direct Benefi- 1. or 3. Trans- (A) or 6. Amount of Deriva- Owned at (D) or cial Title of Exercise Transac- action Disposed Date Exercisable Underlying tive End Indirect Owner- Derivative Price of tion Date Code of (D) and Expiration Securities Security of Year (I) ship Security Derivative (Month/ (Instr. (Instr. 3, Date (Month/ (Instr. 3 (Instr. (Instr. (Instr. (Instr. (Instr. 3) Security Day/Year) 8) 4 or 5) Day/Year) and 4) 5) 4) 4) 4) ---------- ---------- --------- ------- ----------- ---------------- ------------- -------- -------- --------- -------- Amount or Date Expira- Number Exer- tion of (A) (D) cisable Date Title Shares ----- ----- ------- ------ ----- ------ Employee $4.95 (2) 06/30/03 Common 9,000 9,000 D Stock Stock Option (right to buy)(2) Employee $8.50 (3) 01/01/05 Common 6,000 6,000 D Stock Stock Option (right to buy)(3) Employee $10.87 (4) 04/25/06 Common 10,500 10,500 D Stock Stock Option (right to buy)(4) Employee $13.07 (5) 02/25/08 Common 12,600 12,600 D Stock Stock Option (right to buy)(5) Employee $16.23 (6) 07/29/09 Common 10,650 10,650 D Stock Stock Option (right to buy)(6) Employee $18.40 (7) 07/27/10 Common 10,369 10,369 D Stock Stock Option (right to buy)(7) Employee $22.89 11/29/01 A 13,543 (8) 11/29/11 Common 13,543 13,543 D Stock Stock Option (right to buy)(8) Explanation of Responses: (1) Represents shares allocated to the reporting person at 12/31/01, pursuant to the issuer's ESOP. The amount reported was amended in July 2002 based upon information received from the ESOP's third party administrator. (2) The employee stock option vests in five equal annual installments which began on June 30, 1994. (3) The employee stock option vests in five equal annual installments which began on January 1, 1996. (4) The employee stock option vests in five equal annual installments which began on April 25, 1997. (5) The employee stock option vests in five equal annual installments which began on February 25, 1999. (6) The employee stock option vests in five equal annual installments which began on July 29, 2000. (7) The employee stock option vests in five equal annual installments beginning on July 27, 2001. (8) The employee stock option vests in five equal annual installments beginning on November 29, 2002.
/s/ Steven T. Klitzing July 10, 2002 ----------------------------- ---------------- Signature of Reporting Person Date