Midwestone Financial Group Inc - Annual Statement of Changes in Beneficial Ownership (5)
January 30 2008 - 11:27AM
Edgar (US Regulatory)
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FORM 5
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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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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL 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
*
DONOHUE RICHARD R
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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)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
P. O. BOX 1104
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2007
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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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Amount
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(A) or (D)
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Price
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Common Stock
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1540
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D
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Common Stock
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1616
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I
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By Spouse
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Common Stock
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7/31/2007
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7/31/2007
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S
(8)
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34
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D
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$17.10
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0
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I
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By Partnership
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Table II - Derivative Securities Acquired, Disposed of, or 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
(MM/DD/YYYY)
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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 at End of Issuer's Fiscal Year
(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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(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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$9.76
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(1)
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4/26/2011
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Common Stock
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1099
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1099
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D
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Stock Option
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$13.86
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(2)
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4/30/2012
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Common Stock
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1212
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1212
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D
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Stock Option
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$16.00
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(3)
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4/30/2013
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Common Stock
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1448
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1448
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D
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Stock Option
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$18.52
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(4)
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4/30/2014
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Common Stock
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1379
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1379
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D
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Stock Option
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$17.56
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(5)
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4/29/2015
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Common Stock
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1208
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1208
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D
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Stock Option
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$19.07
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(6)
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4/28/2016
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Common Stock
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1000
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1000
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D
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Stock Option
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$17.15
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(7)
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4/26/2017
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Common Stock
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1000
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1000
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D
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Explanation of Responses:
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(
1)
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Total stock options granted as of April 26, 2001 were 1,639, of which 33% were exercisable on or after 04/26/2002, 66% were exercisable on or after 04/26/2003, and 100% were exercisable on or after 04/26/2004.
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(
2)
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Total stock options granted as of April 30, 2002 were 1,212, of which 33% were exercisable on or after 04/30/2003, 66% were exercisable on or after 04/30/2004, and 100% were exercisable on or after 04/30/2005.
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(
3)
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Total stock options granted as of April 30, 2003 were 1,448, of which 33% were exercisable on or after 04/30/2004, 66% were exercisable on or after 04/30/2005, and 100% were exercisable on or after 04/30/2006.
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(
4)
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Total stock options granted as of April 30, 2004 were 1,379, of which 33% were exercisable on or after 04/30/2005, 66% were exercisable on or after 04/30/2006, and 100% were exercisable on or after 04/30/2007.
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(
5)
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Total stock options granted as of April 29, 2005 were 1,208, of which 33% were exercisable on or after 04/29/2006, 66% were exercisable on or after 04/29/2007, and 100% are exercisable on or after 04/29/2008.
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(
6)
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Total stock options granted as of April 28, 2006 were 1,000, of which 33% were exercisable on or after 04/28/2007, 66% are exercisable on or after 04/28/2008, and 100% are exercisable on or after 04/28/2009.
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(
7)
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Total stock options granted as of April 26, 2007 were 1,000, of which 33% are exercisable on or after 04/26/2008, 66% are exercisable on or after 04/26/2009, and 100% are exercisable on or after 04/26/2010.
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(
8)
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Mr. Donohue owned these securities through an investment club. He withdrew from the investment club as of July 31, 2007 and thereby terminated his interest in the shares owned by the investment club.
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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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DONOHUE RICHARD R
P. O. BOX 1104
OSKALOOSA, IA 52577
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X
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Signatures
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Karen K. Binns, under Power of Attorney dated 06/19/03
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1/30/2008
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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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