-----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, K863lLPjOC5JopVEfrZ7eRiJ7kQb+KDgV9VlYt4wKTRv3U4/IFabyNs+i9BD5G34 PnlVrPVGhVgX0e0/Avei4Q== 0000702325-04-000054.txt : 20040308 0000702325-04-000054.hdr.sgml : 20040308 20040308120658 ACCESSION NUMBER: 0000702325-04-000054 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040305 FILED AS OF DATE: 20040308 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KENT S BELASCO CENTRAL INDEX KEY: 0001279182 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10967 FILM NUMBER: 04654011 BUSINESS ADDRESS: STREET 1: FIRST MIDWEST BANCORP INC STREET 2: 300 PARK BLVD SUITE 400 CITY: ITASCA STATE: IL ZIP: 60143 BUSINESS PHONE: 6308757450 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FIRST MIDWEST BANCORP INC CENTRAL INDEX KEY: 0000702325 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] IRS NUMBER: 363161078 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 300 PARK BLVD SUITE 405 STREET 2: P O BOX 459 CITY: ITASCA STATE: IL ZIP: 60143-0459 BUSINESS PHONE: 7088757450 MAIL ADDRESS: STREET 1: 300 PARK BLVD SUITE 405 STREET 2: P O BOOX 459 CITY: ITASCA STATE: IL ZIP: 60143-0459 4 1 bel149.xml X0201 4 2004-03-05 0 0000702325 FIRST MIDWEST BANCORP INC FMBI 0001279182 KENT S BELASCO 300 PARK BOULEVARD, SUITE 405 ITASCA IL 60143 0 1 0 0 EVP, Chief Information Officer Common Stock 1640 D Common Stock 13253 I By NQ Stock Option Gain Deferral Plan Tr Common Stock 3477 I By Profit Sharing Plan Trust Phantom Stock under NQ Retirement Plan 0.0000 2004-03-05 4 A 0 1 33.7000 A Common Stock 1 931 D Non-Qualified Stock Option (right to buy) 10.7734 1998-02-15 2005-02-15 Common Stock 2296 2296 D Non-Qualified Stock Option (right to buy) 12.1600 2006-02-21 Common Stock 4088 4088 D Non-Qualified Stock Option (right to buy) 17.1000 2007-02-19 Common Stock 3033 3033 D Non-Qualified Stock Option (right to buy) 21.7000 2008-02-18 Common Stock 3319 3319 D Non-Qualified Stock Option (right to buy) 18.5500 2009-02-17 Common Stock 4541 4541 D Non-Qualified Stock Option (right to buy) 21.8334 2009-08-18 Common Stock 3405 3405 D Non-Qualified Stock Option (right to buy) 18.4000 2010-02-16 Common Stock 12065 12065 D Non-Qualified Stock Option (right to buy) 22.5000 2011-02-21 Common Stock 10261 10261 D Non-Qualified Stock Option (right to buy) 28.6950 2012-02-20 Common Stock 8369 8369 D Non-Qualified Stock Option (right to buy) 26.2550 2013-02-19 Common Stock 9512 9512 D Non-Qualified Stock Option (right to buy) 32.7150 2014-02-24 Common Stock 7978 7978 D Between February 24, 2004 and March 5, 2004 the reporting person acquired 4 shares of First Midwest Bancorp, Inc. common stock under the First Midwest Bancorp, Inc. Savings and Profit Sharing Plan. The information in this report is based on a plan statement dated February 26, 2004. Shares of phantom stock in the NQ Retirement Plan have a 1-for-1 conversion ratio. Shares of phantom stock in the NQ Retirement Plan are exercisable immediately. Shares of phantom stock in the NQ Retirement Plan are payable in cash following the termination of the reporting person's employment with First Midwest Bancorp, Inc. The stock option vests in two equal annual installments beginning on February 21, 1998. The stock option vests in two equal annual installments beginning on February 19, 1999. The stock option vests in two equal annual installments beginning on February 18, 2000. The stock option vests in two equal annual installments beginning on February 17, 2001. The stock option vests in two equal annual installments beginning on August 18, 2001. The stock option vests in two equal annual installments beginning on February 16, 2002. The stock option vests in two equal annual installments beginning on February 21, 2003. The stock option vests in two equal annual installments beginning on February 20, 2004. The stock option vests in two equal annual installments beginning on February 19, 2005. The stock option vests in two equal annual installments beginning on February 24, 2006. By: Andrea L. Stangl, Attorney-in-fact for 2004-03-05 -----END PRIVACY-ENHANCED MESSAGE-----