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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT 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 1474 (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 Following Reported Transaction(s) (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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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Non-Qualified Stock Option (right to buy) | $ 18.55 | 10/22/2004 | M(2) | 1,580 | (6) | 02/17/2009 | Common Stock | 1,580 | $ 34.16 | 670 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 34.16 | 10/22/2004 | A(7) | 858 | 04/22/2005 | 02/17/2009 | Common Stock | 858 | $ 34.16 | 858 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 18.4 | 10/22/2004 | M(1) | 2,128 | (8) | 02/16/2010 | Common Stock | 2,128 | $ 34.16 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 34.16 | 10/22/2004 | A(9) | 1,147 | 04/22/2005 | 02/16/2010 | Common Stock | 1,147 | $ 34.16 | 1,147 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
VIANO JANET M 300 PARK BOULEVARD, SUITE 405 ITASCA, IL 60143 |
EVP, Group President Retail |
By: Andrea L. Stangl, Attorney-in-fact for | 10/26/2004 | |
**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) | The transaction represents the exercise of 2,128 stock options under the Omnibus Stock & Incentive Plan whereby 1,147 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 981 shares. |
(2) | The transaction represents the exercise of 1,580 stock options under the Omnibus Stock & Incentive Plan whereby 858 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 722 shares. |
(3) | Between May 27, 2004 and October 26, 2004 the reporting person acquired 4 shares of First Midwest common stock under the First Midwest Bancorp, Inc. Dividend Reinvestment Plan. The information in this report is based on a plan statement dated October 19, 2004. |
(4) | Between May 27, 2004 and October 26, 2004 the reporting person acquired 151 shares of First Midwest common stock pursuant to the dividend reinvestment feature under the First Midwest Bancorp, Inc. Savings and Profit Sharing Plan. The information in this report is based on a plan statement dated October 25, 2004. |
(5) | Between May 27, 2004 and October 26, 2004 the reporting person acquired 47 shares of First Midwest Bancorp, Inc. common stock under the First Midwest Bancorp, Inc. Savings and Profit Sharing Plan. The information in this report is based on a plan statement dated October 4, 2004. |
(6) | The stock option vests in two equal annual installments beginning on February 17, 2001. |
(7) | The transaction represents a reload stock option granted under the Omnibus Stock & Incentive Plan to replace the number of shares tendered in the option exercised on 10/22/04. |
(8) | The stock option vests in two equal annual installments beginning on February 16, 2002. |
(9) | The transaction represents a reload stock option granted under the Omnibus Stock & Incentive Plan to replace the number of shares tendered in the option exercised on 10/22/04. |