-----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, PNM+NPEkSyDT846mgj9b5l2/2dFWPQtysLU4phBbu9Fs7MG0+3vXRhPQgo+TurZM XQw6sdibmIjyD0P/RK45oQ== 0000702325-04-000164.txt : 20041101 0000702325-04-000164.hdr.sgml : 20041101 20041101181124 ACCESSION NUMBER: 0000702325-04-000164 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041028 FILED AS OF DATE: 20041101 DATE AS OF CHANGE: 20041101 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: 041111224 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 bel248.xml X0202 4 2004-10-28 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 2004-10-28 4 M 0 920 34.3850 A 2560 D Common Stock 2004-10-28 4 M 0 720 34.3850 A 3280 D Common Stock 2004-10-28 4 S 0 920 35.2500 D 2360 D Common Stock 2004-10-28 4 S 0 720 35.2500 D 1640 D Common Stock 2004-10-29 4 M 0 1488 12.1600 A 18292 I By NQ Stock Option Gain Deferral Plan Tr Common Stock 2004-10-29 4 F 0 516 0 D 17776 I By NQ Stock Option Gain Deferral Plan Tr Common Stock 2004-10-29 4 M 0 2309 17.1000 A 20085 I By NQ Stock Option Gain Deferral Plan Tr Common Stock 2004-10-29 4 F 0 1124 0 D 18961 I By NQ Stock Option Gain Deferral Plan Tr Common Stock 3620 I By Profit Sharing Plan Trust Non-Qualified Stock Option (right to buy) 34.3850 2004-10-28 4 M 0 720 0 D 2004-10-02 2005-02-15 Common Stock 720 0 D Non-Qualified Stock Option (right to buy) 34.3850 2004-10-28 4 M 0 920 0 D 2004-10-02 2006-02-21 Common Stock 920 0 D Non-Qualified Stock Option (right to buy) 12.1600 2004-10-29 4 M 0 1488 12.1600 D 2006-02-21 Common Stock 1488 0 D Non-Qualified Stock Option (right to buy) 35.1300 2004-10-29 4 A 0 516 0 A 2005-04-29 2006-02-21 Common Stock 516 516 D Non-Qualified Stock Option (right to buy) 17.1000 2004-10-29 4 M 0 2309 17.1000 D 2007-02-19 Common Stock 2309 724 D Non-Qualified Stock Option (right to buy) 35.1300 2004-10-29 4 A 0 1124 0 A 2005-04-29 2007-02-19 Common Stock 1124 1124 D Phantom Stock under NQ Retirement Plan 0.0000 2004-10-29 4 A 0 6 34.9890 A Common Stock 6 986 D The transaction represents the exercise of 1,488 stock options under the Omnibus Stock & Incentive Plan whereby 516 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 972 shares. The transaction represents the exercise of 2,309 stock options under the Omnibus Stock & Incentive Plan whereby 1,124 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 1,185 shares. Between May 4, 2004 and November 1, 2004 the reporting person acquired 209 shares of First Midwest common stock pursuant to the dividend reinvestment feature under the First Midwest Bancorp, Inc. Non-Qualified Gain Deferral Plan. The information in this report is based on a plan statement dated October 19, 2004. Between May 27, 2004 and November 1, 2004 the reporting person acquired 52 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 October 6, 2004. Between May 4, 2004 and November 1, 2004 the reporting person acquired 48 shares of First Midwest common stock pursuant to the dividend reinvestment feature under the First Midwest Bancorp, Inc. Savings and Profit Sharing Plan. The information in this report is based on a plan statement dated October 25, 2004. The stock option vests in two equal annual installments beginning on February 21, 1998. The transaction represents a reload stock option granted under the Omnibus Stock & Incentive Plan to replace the number of shares tendered in the option exercised on 10/29/04. The stock option vests in two equal annual installments beginning on February 19, 1999. The transaction represents a reload stock option granted under the Omnibus Stock & Incentive Plan to replace the number of shares tendered in the option exercised on 10/29/04. Shares of phantom stock in the NQ Retirement Plan have a 1-for-1 conversion ratio. Between October 19, 2004 and November 1, 2004 the reporting person acquired 6 shares of First Midwest common stock under the First Midwest Bancorp, Inc Non-Qualified Retirement Plan. The information in this report is based on a plan statement dated October 29, 2004. 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. Between July 28, 2004 and November 1, 2004 the reporting person acquired 6 shares of First Midwest common stock pursuant to the dividend reinvestment feature under the First Midwest Bancorp, Inc. Non-Qualified Retirement Plan. The information in this report is based on a plan statement dated October 19, 2004. By: Andrea L. Stangl, Attorney-in-fact for 2004-11-01 -----END PRIVACY-ENHANCED MESSAGE-----