-----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, A1/4JPMhkt5mjqYXuJrqWswk2wZuNYbkA0X0lLicK1KDJV2inCcl9HsGaY2f3kQa GUH1v0r7d/YcyNot42L3tw== 0001179110-04-022545.txt : 20041206 0001179110-04-022545.hdr.sgml : 20041206 20041206154104 ACCESSION NUMBER: 0001179110-04-022545 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041206 FILED AS OF DATE: 20041206 DATE AS OF CHANGE: 20041206 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: ANDREWS GEORGE H CENTRAL INDEX KEY: 0001309800 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23925 FILM NUMBER: 041186289 BUSINESS ADDRESS: BUSINESS PHONE: 8054736829 MAIL ADDRESS: STREET 1: POST OFFICE BOX 580 STREET 2: 1026 EAST GRAND AVENUE CITY: ARROYO GRANDE STATE: CA ZIP: 93420 3 1 edgar.xml FORM 3 - X0202 3 2004-12-06 0 0001027324 MID-STATE BANCSHARES MDST 0001309800 ANDREWS GEORGE H 1026 EAST GRAND AVENUE ARROYO GRANDE CA 93420 1 0 0 0 Common Stock 23596 D Common Stock 35465 I Trustee of the C. W. Andrews Family Trust Common Stock 4505 I Trustee of the Whiteford Children's Trust Common Stock 30.61 2005-12-01 2014-12-01 Common Stock 20000 I By Company Non-Qualified Stock Option (right to buy) approved and granted to Mr. Andrews by the Board of Directors at the Board of Directors Meeting held November 17, 2004 to be effective December 1, 2004. Mr. Andrews is a newly elected director. Option price established using the closing market value for MDST on December 1, 2004. Non-Qualified Stock Option (right to buy) issued to Mr. Andrews. 20,000 shares were granted at the exercise price of $30.61 per share. Under the terms of the Company's 1996 Stock Option Plan, this option grant vests 20% per year on the anniversary date of the grant for five (5) years at which time the option becomes 100% vested. Optionee has another five (5) years from the 100% vesting anniversary date to exercise the shares in accordance with the terms and conditions of the Company's Plan. No shares under this option are available for exercise until December 1, 2005 at which time it will be 20% vested. George H. Andrews 2004-12-06 -----END PRIVACY-ENHANCED MESSAGE-----