SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response: 1.0
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
  
Form 3 Holdings Reported.
  
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
MILLS DOUGLAS C

(Last) (First) (Middle)
100 WEST UNIVERSITY AVENUE

(Street)
CHAMPAIGN IL 61820

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FIRST BUSEY CORP /NV/ [ BUSE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2009
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 at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 12/22/2009 G 200,000 D $0 929,261 I Linda M. Mills Trust dtd 12/18/1989, Douglas C. Mills, Trustee
Common Stock 12/22/2009 G 74,173(1) D $0 1,257,838 I Douglas C. Mills Trust dtd 12/18/1989, Douglas C. Mills, Trustee
Common Stock 12/31/2009 A 34 A $0 39,958 I ESOP Plan
Common Stock 12/31/2009 A 5,908 A $0 21,720 I Profit Sharing 401(k) Plan
Common Stock 1,705,552 I Mills Investment LP
Common Stock 41,000 I Mills Family Foundation
Common Stock 45,000 I Douglas C. Mills, IRA
Common Stock 44,178 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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Common Stock $14.56 04/16/2005 12/16/2010 Stock Option 45,000 45,000 D
Common Stock $20.16 01/26/2009 12/15/2011 Stock Option 15,000 15,000 D
Common Stock $17.12 05/01/2009 12/15/2015 Stock Option 7,500 7,500 D
Common Stock $7.53 06/01/2010 06/30/2019 Stock Option 7,500 7,500 D
Explanation of Responses:
1. On December 22, 2009, a charitable remainder unitrust (a "CRUT") with respect to which Mr. Mills was the settlor and Trustee terminated according to its terms and made a final payment to Mr. Mills of 12,127 shares and distributed the remaining 74,173 shares to the charitable organization named as the remainderman, for a total distribution of 86,300 shares. The 74,173 shares distributed by the "CRUT" to the charitable organization was an exempt gift. The distribution of 12,127 shares by the CRUT to Mr. Mills was exempt under Rule 16a-13 as a change in form of ownership and such shares are now included under Mr. Mills' direct holdings of 44,178 shares.
Remarks:
/s/ Douglas C. Mills 02/12/2010
** 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.