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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 | |
KOZAK MICHAEL J ONE PIERCE PLACE SUITE 1500 ITASCA, IL 60143 |
EVP and Chief Credit Officer |
Andrea L. Stangl, Attorney-in-fact for Michael J. Kozak | 05/22/2012 | |
**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) | On May 20, 2009 the Issuer granted the Reporting Person a Restricted Stock Award (RSA) of 11,570 restricted shares of First Midwest Bancorp, Inc. Common Stock under the First Midwest Bancorp, Inc. Omnibus Stock Incentive Plan (Plan) which were scheduled to vest in two equal annual installments on the second and third anniversary of the date of grant. On May 20, 2012, 5,785 shares of the remaining RSAs vested, of which 1,820 shares were surrendered by the Reporting Person in order to satisfy tax withholding obligations. This form is being filed to reflect the surrender of such shares to satisfy the Reporting Person's tax withholding obligation. |
(2) | Between February 22, 2012 and May 22, 2012 the Reporting Person acquired 1 share of First Midwest Bancorp, Inc. Common Stock pursuant to the First Midwest Bancorp, Inc. Dividend Reinvestment Plan. The information reported in this line item includes such shares as reported in a plan statement dated April 17, 2012. |
(3) | Between February 22, 2012 and May 22, 2012, 2 shares were sold in satisfaction of quarterly plan administration fees and the Reporting Person acquired the following shares of First Midwest Bancorp, Inc. Common Stock under the First Midwest Bancorp, Inc. Savings and Profit Sharing Plan: (a) 32 shares pursuant to quarterly match contributions from the Company; (b) 7 shares pursuant to the Dividend Reinvestment feature of the Plan; and (c) 154 shares pursuant to payroll contributions. This information is based on plan statements dated April 5, 2012, April 5, 2012 April 24, 2012 and May 10, 2012, respectively. |