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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
John M. Morrison Revocable Trust #4 102 S. CLINTON STREET P.O. BOX 1700 IOWA CITY, IA 52240 |
X |
Kenneth R. Urmie, under Power of Attorney dated April 27, 2015, for John M. Morrison, Trustee, for the John M. Morrison Revocable Trust #4 | 05/04/2015 | |
**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) | Shares received in exchange for shares of the common stock of Central Bancshares, Inc., a privately held Minnesota corporation, held by the John M. Morrison Revocable Trust #4 in connection with the merger of Central Bancshares, Inc. with and into MidWestOne Financial Group, Inc., pursuant to the terms and conditions of that certain Agreement and Plan of Merger, dated November 20, 2014, between Central Bancshares, Inc. and MidWestOne Financial Group, Inc. MidWestOne Financial Group, Inc. is the surviving corporation. The John M. Morrison Revocable Trust #4, as the sole shareholder of Central Bancshares, Inc., received $64.0 million in cash and 2,723,083 shares of MidWestOne Financial Group, Inc. as merger consideration. On May 1, 2015, the closing date of the merger, the closing price of MidWestOne Financial Group, Inc. common stock was $29.31 per share. |