Midwestone Financial Group Inc - Statement of Changes in Beneficial Ownership (4)
October 09 2007 - 10:56AM
Edgar (US Regulatory)
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FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
CAMPBELL THOMAS W
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2. Issuer Name
and
Ticker or Trading Symbol
MIDWESTONE FINANCIAL GROUP INC
[
OSKY
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
REGIONAL PRESIDENT/SUBSIDIARY
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(Last)
(First)
(Middle)
P. O. BOX 1104
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3. Date of Earliest Transaction
(MM/DD/YYYY)
10/5/2007
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(Street)
OSKALOOSA, IA 52577
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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10/5/2007
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10/5/2007
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M
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850
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A
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$12.00
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3150
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D
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Common Stock
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10/5/2007
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10/5/2007
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M
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3750
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A
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$8.375
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6900
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D
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Common Stock
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4160
(1)
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I
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By ESOP
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option
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$19.875
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(2)
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12/31/2007
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Common Stock
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4000
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4000
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D
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Stock Option
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$16.875
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(3)
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12/31/2008
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Common Stock
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2000
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2000
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D
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Stock Option
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$12.00
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10/5/2007
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10/5/2007
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M
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850
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(4)
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12/31/2009
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Common Stock
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850
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$0
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0
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D
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Stock Option
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$8.375
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10/5/2007
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10/5/2007
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M
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3750
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(5)
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12/29/2010
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Common Stock
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3750
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$0
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0
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D
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Stock Option
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$11.25
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(6)
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12/31/2011
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Common Stock
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4000
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4000
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D
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Stock Option
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$16.01
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(7)
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12/31/2012
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Common Stock
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5000
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5000
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D
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Stock Option
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$18.76
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(8)
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12/31/2013
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Common Stock
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5250
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5250
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D
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Stock Option
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$20.84
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(9)
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12/31/2014
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Common Stock
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5000
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5000
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D
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Stock Option
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$17.77
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(10)
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12/30/2015
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Common Stock
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2100
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2100
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D
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Explanation of Responses:
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(
1)
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Shares held in MidWestOne Financial Group, Inc. Employee Stock Ownership Plan, for which Mr. Campbell is an administrator, and allocated to Mr. Campbell's account as of December 31, 2006.
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(
2)
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Total stock options granted as of December 31, 1997 were 4,000, of which 33% were exercisable on or after 12/31/1998, 66% were exercisable on or after 12/31/1999, and 100% were exercisable on or after 12/31/2000.
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(
3)
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Total stock options granted as of December 31, 1998 were 2,000, of which 33% were exercisable on or after 12/31/1999, 66% were exercisable on or after 12/31/2000, and 100% were exercisable on or after 12/31/2001.
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(
4)
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Total stock options granted as of December 31, 1999 were 1,000, of which 33% were exercisable on or after 12/31/2000, 66% were exercisable on or after 12/31/2001, and 100% were exercisable on or after 12/31/2002.
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(
5)
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Total stock options granted as of December 29, 2000 were 3,750, of which 33% were exercisable on or after 12/29/2001, 66% were exercisable on or after 12/29/2002, and 100% were exercisable on or after 12/29/2003.
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(
6)
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Total stock options granted as of December 31, 2001 were 4,000, of which 33% were exercisable on or after 12/31/2002, 66% were exercisable on or after 12/31/2003, and 100% were exercisable on or after 12/31/2004.
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(
7)
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Total stock options granted as of December 31, 2002 were 5,000, of which 33% were exercisable on or after 12/31/2003, 66% were exercisable on or after 12/31/2004, and 100% were exercisable on or after 12/31/2005.
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(
8)
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Total stock options granted as of December 31, 2003 were 5,250, of which 33% were exercisable on or after 12/31/2004, 66% were exercisable on or after 12/31/2005, and 100% were exercisable on or after 12/31/2006.
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(
9)
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Total stock options granted as of December 31, 2004 were 5,000, of which 33% were exercisable on or after 12/31/2005, 66% were exercisable on or after 12/31/2006, and 100% are exercisable on or after 12/31/2007.
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(
10)
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Total stock options granted as of December 30, 2005 were 2,100, of which 33% were exercisable on or after 12/30/2006, 66% are exercisable on or after 12/30/2007, and 100% are exercisable on or after 12/30/2008.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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CAMPBELL THOMAS W
P. O. BOX 1104
OSKALOOSA, IA 52577
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REGIONAL PRESIDENT/SUBSIDIARY
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Signatures
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/s/Thomas W. Campbell
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10/8/2007
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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