5 1 c67459ke5.txt ANNUAL STMT OF CHANGES IN BENEFICIAL OWNERSHIP ------ FORM 5 ------ / / Check box if no UNITED STATES SECURITIES AND EXCHANGE COMMISSION longer subject to WASHINGTON, DC 20549 Section 16. Form 4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP obligations may continue. See Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Instruction 1(b) Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 / / Form 3 Holdings Reported / / Form 4 Transactions Reported ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer (Check all applicable) X Director 10% Owner ---- --- X Officer (give Other (Specify ---- title --- below) Trilling, Donald M. CIB Marine Bancshares, Inc. (not listed) below Chairman ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS Identification 4. Statement for 7. Individual or Joint/Group Filing Number of Reporting Month/Year (Check applicable line) Person, if an Entity X Form filed by One Reporting (Voluntary) ---- Person 640 Ballantrae Drive December, 2001 Form Filed by More Than One ------------------------------------------- ------------------- ---- Reporting Person (Street) 5. If Amendment, Northbrook, IL 60062 Date of Original ------------------------------------------- (Month/Year) (City) (State) (Zip) ------------------------------------------------------------------------------------------------------------------------------------ TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature (Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In- Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct (Instr. 8) End of Issuer's Direct Benefi- (Month/ Fiscal Year (D) or cial Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner- Year) Amount (A) or (D) Price (I) ship (Instr. 4) (Instr. 4) Common Stock 130,745 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/10/01 G 3,528 D 1,472 I Trust ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 68,705 I By spouse's Trust ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
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 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv- Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative Deriv- Day/ Disposed of (D) (Month/Day/ Secur- ative Year) (Instr. 3, 4, Year) ity Security and 5) (Instr. 5) ----------------------------------- Date Expira- Amount or --------------- Exer- tion Title Number of (A) (D) cisable Date Shares ------------------------------------------------------------------------------------------------------------------------------------ Director Stock Option Common (right to buy)(1) $ 8.50 (1) 1/1/05 stock 1,500 ------------------------------------------------------------------------------------------------------------------------------------ Director Stock Option Common (right to buy)(2) $10.87 (2) 4/25/06 stock 3,300 ------------------------------------------------------------------------------------------------------------------------------------ Director Stock Option Common (right to buy)(3) $13.07 (3) 2/25/08 stock 15,000 ------------------------------------------------------------------------------------------------------------------------------------ Director Stock Option Common (right to buy)(4) $16.23 (4) 7/29/09 stock 5,550 ------------------------------------------------------------------------------------------------------------------------------------ Director Stock Option Common (right to buy)(5) $18.40 (5) 7/27/10 stock 7,500 ------------------------------------------------------------------------------------------------------------------------------------ Director Stock Option Common (right to buy)(6) $22.89 11/29/01 A 5,000 (6) 11/29/11 stock 5,000 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 9. Number of 10. Ownership 11. Nature of Derivative of Derivative Indirect Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------- 1,500 D ------------------------------------------------------------------------------------------------------- 3,300 D ------------------------------------------------------------------------------------------------------- 15,000 D ------------------------------------------------------------------------------------------------------- 5,550 D ------------------------------------------------------------------------------------------------------- 7,500 D ------------------------------------------------------------------------------------------------------- 5,000 D ------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) 750 shares of the director stock option vested on January 1, 1998, and the remaining 750 shares vested on January 1, 2000. (2) The director stock option vests in five equal annual installments which began on April 25, 1997. (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/ DONALD M. TRILLING 2/14/02 ------------------------------- ------- **Signature of 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. Page 2 If space provided is insufficient, see Instruction 6 for procedure.