SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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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).
1. Name and Address of Reporting Person*
VAN LOAN CHARLES C

(Last) (First) (Middle)
236 E. WASHINGTON ST.

(Street)
IONIA, MI 48846

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
INDEPENDENT BANK CORP /MI/ [ IBCP ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President & CEO
3. Date of Earliest Transaction (Month/Day/Year)
10/06/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 10/06/2003 M 19,538 A $7.168 125,483 D
Common Stock 10/06/2003 F 11,002 D $28.37 114,481 D
Common Stock 10/06/2003 M 5,484 A $6.806 119,965 D
Common Stock 10/06/2003 F 3,046 D $28.37 116,919 D
Common Stock 10/06/2003 M 14,089 A $10.788 131,008 D
Common Stock 10/06/2003 F 8,984 D $28.37 122,024 D
Common Stock 10/06/2003 M 5,485 A $10.989 127,509 D
Common Stock 10/06/2003 F 3,520 D $28.37 123,989(1)(2) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (Right to buy) 1/00 $7.168 10/06/2003 M 19,538 01/18/2001 01/18/2010 Common Stock 19,538 $7.168 13,953.14 D
Employee Stock Option (Right to buy) 1/01 $10.788 10/06/2003 M 14,089 01/21/2002 01/21/2011 Common Stock 14,089 $10.788 9,268.45 D
Employee Stock Option (Right to buy) 10/03 reload 1 $28.37 10/06/2003 A 11,002 10/03/2004 01/18/2010 Common Stock 11,002 $28.37 11,002 D
Employee Stock Option (Right to buy) 10/03 reload2 $28.37 10/06/2003 A 3,046 10/03/2004 04/20/2010 Common Stock 3,046 $28.37 3,046 D
Employee Stock Option (Right to buy) 10/03 reload3 $28.37 10/06/2003 A 8,984 10/03/2004 01/21/2011 Common Stock 8,984 $28.37 8,984 D
Employee Stock Option (Right to buy) 10/03 reload4 $28.37 10/06/2003 A 3,520 10/03/2004 04/17/2011 Common Stock 3,520 $28.37 3,520 D
Employee Stock Option (Right to buy) 4/00c $6.806 10/06/2003 M 5,484 04/18/2001 04/18/2010 Common Stock 5,484 $6.806 0 D
Employee Stock Option (Right to buy) 4/01 $10.989 10/06/2003 M 5,485 04/17/2002 04/17/2011 Common Stock 5,485 $10.989 0 D
Explanation of Responses:
1. Totals reflect a 10% stock dividend allocated October 2, 2003
2. The reporting person no longer has a reportable beneficial interest in 2,487 shares of IBCP common stock owned by his daughter and included in the reporting person's prior ownership reports.
/s/ Charles C. Van Loan 10/06/2003
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.