4 1 j6821_4.htm 4

FORM 4

 o Check this box if no longer subject to Section 16.  Form 4 or Form 5 obligations may continue.
See Instruction 1(b).

(Print or Type Responses)

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, 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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 1. Name and Address of Reporting Person *



Sackrider           Harry           H.

(Last)            (First)              (Middle)


1026 East Grand Avenue

(Street)


Arroyo Grande           CA           93420

(City)       (State)          (Zip)

 

 2. Issuer Name and Ticker
    or Trading Symbol

Mid-State Bancshares

MDST

 



 3. I.R.S. Identification
    Number of Reporting
    Person, if an entity
    (voluntary)



 4. Statement for
 (Month/Day/Year)

January 24, 2003





 5. If Amendment, Date of
   Original (Month/Day/Year)

N/A / N/A

 6. Relationship of Reporting Person(s) to Issuer

     (Check all applicable)

 o Director

 

 o 10% Owner

 

 ý Officer (give title below)

 

 o Other (specify below)

Executive Vice President/Chief Credit Officer

 


 7. Individual or Joint/Group
     Filing (Check Applicable Line)

 
ý Form filed by One Reporting Person

 
o 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

12/31/02

 

P

 

6.777760

A

 

2,339.803230

D/401(k) Plan

 

Common Stock

01/23/03

 

P

 

7.299184

A

 

2,347.102414

D/401(k) Plan

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

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 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 Securities: 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

Incentive Stock Option (right to buy)

$15.00

 

 

 

 

 

 

9/9/99

(1)

9/9/08

Common Stock

6,000

 

4,800 Vested/Available for Exercise

I

By Company

Incentive Stock Option (right to buy)

$15.06

 

 

 

 

 

 

9/13/01

(1)

9/13/10

Common Stock

10,000

 

4,000 Vested/Available for Exercise

I

By Company

Incentive Stock Option

(right to buy)

$17.40

 

 

 

 

 

 

3/13/03

(1)

3/13/12

Common Stock

5,000

 

0 Vested until 3/13/2003

I

By Company

Non-Qualified Stock Option (right to buy)

(2)

$17.00

 

 

 

 

 

 

12/11/03

(1)

12/11/12

Common Stock

815

 

0 Vested until 12/11/2003

I

By Company

Incentive Stock Option (right to buy)

$17.00

 

 

 

 

 

 

12/11/03

(1)

12/11/12

Common Stock

14,185

 

0 Vested until 12/11/2003

I

By Company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Explanation of Responses:

(1)  Options vest 20% per year on the anniversary date of the grant for five (5) years at which time the option is 100% vested.  Optionee has another five (5) years from the five (5) year "100% vesting" anniversary date to exercise the shares in accordance with the terms and conditions of the 1996 Stock Option Plan.

 

(2)  15,000 shares granted as an ISO under the 1996 Stock Option Plan.  Due to the $100K limitation, 815 shares were issued and treated as a non-qualified stock option, the remaining 14,185 shares granted were issued as an ISO.

 

 

 

 

/s/ Harry H. Sackrider

** Signature of Reporting Person

1/24/2003

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.

 

 

http://www.sec.gov/divisions/corpfin/forms/form4.htm

Last update: 09/05/2002