-----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, OZNr3v6DMq1trXOQPv1TZUjQQRj8nCpFguTYkb7h/65CqgEK4xkCLR5GxRBMMpIN 5hi/u85kX32ll7knBMjsNw== 0000895813-03-000047.txt : 20030212 0000895813-03-000047.hdr.sgml : 20030212 20030212172629 ACCESSION NUMBER: 0000895813-03-000047 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030212 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CIB MARINE BANCSHARES INC CENTRAL INDEX KEY: 0000861955 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 371203599 STATE OF INCORPORATION: WI FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24149 FILM NUMBER: 03555606 BUSINESS ADDRESS: STREET 1: N27 W24025 PAUL COURT CITY: PEWAUKEE STATE: WI ZIP: 53072 BUSINESS PHONE: 4146956010 MAIL ADDRESS: STREET 1: N27 W24025 PAUL COURT CITY: PEWAUKEE STATE: WI ZIP: 53072 FORMER COMPANY: FORMER CONFORMED NAME: CENTRAL ILLINOIS BANCORP INC DATE OF NAME CHANGE: 19980427 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: BAKER NORMAN CENTRAL INDEX KEY: 0001079597 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O CENTRAL ILLINOIS BANCORP INC STREET 2: N27 W24025 PAUL COURT CITY: PEWAUKEE STATE: WI ZIP: 53072 BUSINESS PHONE: 4146956010 MAIL ADDRESS: STREET 1: C/O CENTRAL ILLINOIS BANCORP INC STREET 2: N27 W24025 PAUL COURT CITY: PEWAUKEE STATE: WI ZIP: 53072 5 1 xbaker-5.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: Baker, Norman E. 14493 South Padre Island Drive Suite A, Box 321 Corpus Christi, TX 78418 2. Issuer Name and Ticker or Trading Symbol: CIB Marine Bancshares, Inc. (not listed) 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary): 4. Statement for Month/Year: December, 2002 5. If Amendment, Date of Original (Month/Year): 6. Relationship of Reporting Person(s) to Issuer (Check all applicable): (x) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 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 2A Securities 6. 7. 2. Deemed Beneficially Ownership Nature of 1. Transaction Execution 3. 4. Owned at End Form; Direct Indirect Title of Date Date, if any Transaction Securities Acquired (A) or of Issuer's (D) or Beneficial Security (Month/Day/ (Month/Day/ Code Disposed of (D) Fiscal Year Indirect (I) Ownership (Instr. 3) Year) (Year) (Instr. 8) (Instr. 3, 4 and 5) (Instr. 3 and 4) (Instr. 4) (Instr. 4) ---------- ----------- ----------- ------------ ---------------------------- ---------------- ------------ ---------- Amount (A) or (D) Price ------ ---------- ----- Common Stock 369,450 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., Puts, Calls, Warrants, Options, Convertible Securities) 10. 9. Owner- Number of ship Deriva- of 5. tive Deriva- 11. Number of 8. Securi- tive Nature 0 2. 3A. Derivative Price ties Secur- of In- Conver- Deemed Securities 7. of Benefi- ity: direct sion or Execu- 4. Acquired Title and Deriva- cially Direct Bene- 1. Exercise 3. tion Trans- (A) or 6. Amount of tive Owned at (D) or ficial Title of Price of Transac- Date,if action Disposed Date Exercisable Underlying Secur- End Indirect Owner- Derivative Deriva- tion Date any, Code of (D) and Expiration Securities ity of Year (I) ship Security tive (Month/ (Month/ (Instr. (Instr. 3, Date (Month/ (Instr. 3 (Instr. (Instr. (Instr. (Instr. (Instr. 3) Security Day/Year) 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 ----- ----- ------- ------- ----- ------- Director $8.50 (1) 1/1/05 Common 1,500 1,500 D Stock stock Option (right to buy) (1) Director $10.87 (2) 4/25/06 Common 1,950 1,950 D Stock stock Option (right to buy) (2) Director $13.07 (3) 2/25/08 Common 15,000 15,000 D Stock stock Option (right to buy) (3) Director $16.23 (4) 7/29/09 Common 5,550 5,550 D Stock stock Option (right to buy) (4) Director $18.40 (5) 7/27/10 Common 7,500 7,500 D Stock stock Option (right to buy) (5) Director $22.89 (6) 11/29/11 Common 5,000 5,000 D Stock stock Option (right to buy) (6) Explanation of Responses: (1) The director stock option vested on January 1, 2000. (2) The director stock option vested on April 25, 2001. (3) The director stock option vests in five equal annual installments which began on February 25, 1999. (4) The director stock option vests in five equal annual installments which began on July 29, 2000. (5) The director stock option vests in five equal annual installments which began on July 27, 2001. (6) The director stock option vests in five equal annual installments which began on November 29, 2002.
/s/ Norman E. Baker January 30, 2003 ----------------------------- ---------------- Signature of Reporting Person Date -----END PRIVACY-ENHANCED MESSAGE-----