-----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, P/8+Jxn/1yCIoVvw7Gs2950AAmq232AGgJQxyPUwm5WH+czJDyPULHpJfwHbkXwK u4x08GNIjUk1gGaCdW9WfQ== 0000034782-04-000002.txt : 20040129 0000034782-04-000002.hdr.sgml : 20040129 20040129103212 ACCESSION NUMBER: 0000034782-04-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040129 FILED AS OF DATE: 20040129 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: QUALEY ALLEN RUSSELL CENTRAL INDEX KEY: 0001217076 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-06233 FILM NUMBER: 04550895 MAIL ADDRESS: STREET 1: P O BOX 1602 CITY: SOUTH BEND STATE: IN ZIP: 46634 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: 1ST SOURCE CORP CENTRAL INDEX KEY: 0000034782 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 351068133 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 NORTH MICHIGAN STREET CITY: SOUTH BEND STATE: IN ZIP: 46601 BUSINESS PHONE: 5742352702 MAIL ADDRESS: STREET 1: P O BOX 1602 STREET 2: P O BOX 1602 CITY: SOUTH BEND STATE: IN ZIP: 46634 FORMER COMPANY: FORMER CONFORMED NAME: FBT BANCORP INC DATE OF NAME CHANGE: 19820818 4 1 qua163.xml X0201 4 2004-01-29 0 0000034782 1ST SOURCE CORP SRCE 0001217076 QUALEY ALLEN RUSSELL P.O. BOX 1602 SOUTH BEND IN 46634 0 1 0 0 Executive Vice President Common Stock 2004-01-29 4 D 0 2721 0 D 60119.00 D Common Stock 2004-01-29 4 J 0 913 0 A 11663.00 I By 401(k) Common Stock 18539.00 I By Immediate Family Due to a forfeiture of stock under the Executive Incentive Plan (EIP) 401(k) Benefit: Between July 1, 2002, and June 30, 2003, the reporting person acquired a net 913 shares of 1st Source Corp. common stock under the 401(k) plan. The information is based on a plan statement dated as of June 30, 2003. /s/ Qualey, Allen R. 2004-01-29 -----END PRIVACY-ENHANCED MESSAGE-----