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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 | ||||||||
Incentive Stock Option (right to buy) | $ 9.42 | 05/06/2005 | M | 388 | 01/12/2000(4) | 01/01/2008 | Common Stock | 388 | $ 0 | 0 | D | ||||
Incentive Stock Option (right to buy) | $ 12.65 | 01/12/2000(4) | 03/14/2009 | Common Stock | 775 | 775 | D | ||||||||
Incentive Stock Option (right to buy) | $ 11 | 02/14/2001(4) | 02/14/2010 | Common Stock | 3,000 | 3,000 | D | ||||||||
Stock Option (right-to-buy) | $ 23 | 06/21/2005(5) | 06/21/2014 | Common Stock | 2,000 | 2,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
THOMAS DENNIS 220 FEDERAL DRIVE CORYDON, IN 47115 |
Senior Vice President |
By: Samuel E. Uhl, Power of Attorney | 05/06/2005 | |
**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) | This form reflects increases in beneficial ownership resulting from exempt acquisitions under an ESOP pursuant to Rule 16b-3(c). |
(2) | Stock Awards granted pursuant to the First Capital, Inc. 1999 Stock-Based Incentive Plan will vest in five equal annual installments commencing on February 15, 2003. |
(3) | Since the reporting person's last report 111 shares previously held through Stock Award have vested and are now owned directly. |
(4) | Options are fully vested and exercisable. |
(5) | Stock Options granted pursuant to the First Capital, Inc. 1999 Stock-Based Incentive Plan vest in five annual installments commencing on June 21, 2005. |