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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 2270 (9-02) |
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) |
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 at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Stock Option | $ 16.86 | Â | Â | Â | Â | Â | Â (1) | 12/31/2012 | Common Stock | Â | 6,650 | Â | ||
Stock Option | $ 19.75 | Â | Â | Â | Â | Â | Â (1) | 12/31/2013 | Common Stock | Â | 6,982 | Â | ||
Stock Option | $ 21.94 | Â | Â | Â | Â | Â | Â (1) | 12/31/2014 | Common Stock | Â | 6,650 | Â | ||
Stock Option | $ 18.71 | Â | Â | Â | Â | Â | Â (1) | 12/31/2015 | Common Stock | Â | 2,850 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HOWARD CHARLES S 102 SOUTH CLINTON STREET IOWA CITY, IA 52240 |
 X |  |  |  |
Kenneth R. Urmie, under Power of Attorney dated January 22, 2009 | 01/22/2010 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Fully vested. |
(2) | This report is for the year as accrued on the same dates as cash dividends were paid on the underlying stock. |
(3) | These RSU shares represent the dividend equivalent that would have been paid on the number of shares of unvested restricted stock units (RSUs) awarded, plus prior dividend equivalents accruing on such RSUs. All such dividend equivalents credited will be treated as RSUs. As RSUs, these dividend equivalents are subject to vesting, forfeiture and termination in accordance with the terms of the original awards. |
(4) | Shares held in MidWestOne Financial Group, Inc. Employee Stock Ownership Plan and allocated to reporting person's account as of December 31, 2009. |