5 1 c67459ce5.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) Director 10% Owner ---- --- X Officer (give Other (Specify ---- title --- below) below Senior Vice President, Secretary Straka Donald J. CIB Marine Bancshares, Inc. (not listed) and General Counsel ------------------------------------------------------------------------------------------------------------------------------------ (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) December, 2001 ---- Person N53 W14147 Invery Drive Form Filed by More Than One ------------------------------------------- ------------------- ---- Reporting Person (Street) 5. If Amendment, Menomonee Falls WI 53051 -------------------- 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 12/10/01 G 416 A 3,466 D ------------------------------------------------------------------------------------------------------------------------------------ Common stock 4,800 (1) I By SIG; a general partnership ------------------------------------------------------------------------------------------------------------------------------------ Common stock 828.7 (2) I By ESOP ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
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 ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock $13.73 (3) 9/24/07 Common 6,900 Option (right to Stock buy)(3) ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock $13.07 (4) 2/25/08 Common 15,450 Option (right to Stock buy)(4) ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock $16.23 (5) 7/29/09 Common 11,850 Option (right to Stock buy)(5) ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock $18.40 (6) 7/27/10 Common 11,372 Option (right to Stock buy)(6) ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock $22.89 11/29/01 A 13,543 (7) 11/29/11 Common 13,543 Option (right to Stock buy)(7) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 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) ------------------------------------------------------------------------------------------------------- 6,900 D ------------------------------------------------------------------------------------------------------- 15,450 D ------------------------------------------------------------------------------------------------------- 11,850 D ------------------------------------------------------------------------------------------------------- 11,372 D ------------------------------------------------------------------------------------------------------- 13,543 D ------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. (2) Represents shares allocated to the reporting person, at 12/31/01, pursuant to the issuer's ESOP. (3) The employee stock option vests in five equal annual installments which began on September 24, 1998. (4) The employee stock option vests in five equal annual installments which began on February 25, 1999. (5) The employee stock option vests in five equal annual installments which began on July 29, 2000. (6) The employee stock option vests in five equal annual installments which began on July 27, 2001. (7) The employee stock option vests in five equal annual installments beginning on November 29, 2002. /s/ DONALD J. STRAKA 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.