-----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, IYFQZrH9npZfq+Oa6m4+CDbAO2Kb+GNcOnULooVAIc17z3VXb1Td9PcsBjsgOgVs 7Ebydaf/ZvTI3TwVO21a9g== 0000034782-04-000005.txt : 20040205 0000034782-04-000005.hdr.sgml : 20040205 20040205100745 ACCESSION NUMBER: 0000034782-04-000005 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040203 FILED AS OF DATE: 20040205 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: 04568775 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 qua165.xml X0201 4 2004-02-03 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 2004-02-03 4 M 0 6410 8.97 A 66529.00 D Common Stock 2004-02-03 4 F 0 2678 21.48 D 63851.00 D Common Stock 11663.00 I By 401(k) Common Stock 18539.00 I By Immediate Family Stock Option (Right to Buy)1994 8.97 2004-02-03 4 M 0 6410 0 D 1995-10-31 2004-10-31 Common Stock 6410.00 0.00 D Stock Option (Right to Buy)1996 12.44 1997-07-31 2006-07-31 Common Stock 16675.00 16675.00 D Stock Option (Right to Buy)1997 16.30 1998-04-17 2007-04-17 Common Stock 13340.00 13340.00 D Stock Option (Right to Buy)1998 31.13 1999-07-21 2008-07-21 Common Stock 60638.00 60638.00 D One-fifth of the shares will become exercisable on each of the following dates: 4/17/98, 4/17/99, 4/17/2000, 4/17/2001 and 4/17/2002. By: Patrick C. Doran, Attorney-in-fact 2004-02-03 -----END PRIVACY-ENHANCED MESSAGE-----