-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Gs+a0XS69WYOkmffq8GRGuqVO/d42r2lSBjexpfgl/rYm4RpZyO9WN6bpA07kgRD 15uA7dFmC2Ukseeko1nKrw== 0001179110-04-011581.txt : 20040526 0001179110-04-011581.hdr.sgml : 20040526 20040526181036 ACCESSION NUMBER: 0001179110-04-011581 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040518 FILED AS OF DATE: 20040526 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MID-STATE BANCSHARES CENTRAL INDEX KEY: 0001027324 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 770442667 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1026 GRAND AVE CITY: ARROYO GRANDE STATE: CA ZIP: 93420 BUSINESS PHONE: 8054737700 MAIL ADDRESS: STREET 1: 1026 GRAND AVE CITY: ARROYO GRANDE STATE: CA ZIP: 93420 FORMER COMPANY: FORMER CONFORMED NAME: MID STATE BANCSHARES DATE OF NAME CHANGE: 19980820 FORMER COMPANY: FORMER CONFORMED NAME: BSM BANCORP DATE OF NAME CHANGE: 19961121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BELLO GRACIA B CENTRAL INDEX KEY: 0001198891 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23925 FILM NUMBER: 04833266 BUSINESS ADDRESS: STREET 1: MID-STATE BANCSHARES STREET 2: POST OFFICE BOX 580 CITY: ARROYO GRANDE STATE: CA ZIP: 93421-0580 BUSINESS PHONE: 8054736829 MAIL ADDRESS: STREET 1: MID-STATE BANCSHARES STREET 2: POST OFFICE BOX 580 CITY: ARROYO GRANDE STATE: CA ZIP: 93421-0580 4 1 edgar.xml FORM 4 - X0202 4 2004-05-18 1 0001027324 MID-STATE BANCSHARES MDST 0001198891 BELLO GRACIA B 1026 EAST GRAND AVENUE ARROYO GRANDE CA 93420 1 0 0 0 Common Stock 2004-05-18 4 J 0 0 A 12274 D Common Stock 15.50 2004-05-18 4 J 0 0 15.50 A 2003-08-12 2008-08-12 Common Stock 0 20000 I By Company Mid-State Bancshares Common Stock (MDST). Mrs. Bello's term as a director of Mid-State Bancshares expired on May 18, 2004 and she did not run for re-election. This Form 4 is being filed to report Mrs. Bello's ending balance of Mid-State Bancshares as of May 18, 2004. As of this date, this was Mrs. Bello's total holdings and she is no longer subject to Section 16. No additional shares have been acquired or disposed of by Mrs. Bello as of her retirement date of May 18, 2004. Closing market value of Mid-State Bancshares (MDST) as of May 18, 2004 is $21.53 per share. Balance of Mid-State Bancshares common stock held by Mrs. Bello at the close of business on May 18, 2004. Non-Qualified Stock Option (right to buy) - 20,000 shares granted at an exercise price of $15.50 per share on August 12, 1998. Option is fully vested and the balance of the shares are available for exercise by Mrs. Bello. Shares granted at fair market value as of August 12, 1998. Mrs. Bello was appointed a director emeritus by the Board of Directors on May 19, 2004. In accordance with the Company's policy, the term of a director emeritus is 3-years and is renewable by the Board of directors. As a director emeritus, these shares are available to Mrs. Bello for exercise until three (3) months from the date in which her term ends as a director emeritus. No shares have been exercised by Mrs. Bello under this grant. Total number of shares eligible for exercise by Mrs. Bello at the exercise price of $15.50 per share. Shares granted to Mrs. Bello by Company on August 12, 1998. Under this grant, no shares have been exercised to date. Gracia B. Bello 2004-05-26 -----END PRIVACY-ENHANCED MESSAGE-----