-----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, KiiTANRef+CFdXckSWTHFVIsI9M1crRR4jzyzYuQe6QWZIEBB5XS2vnv/s2dP+D6 PM0scOdEzzaiX2v3INScRg== 0000702325-05-000003.txt : 20050104 0000702325-05-000003.hdr.sgml : 20050104 20050104170158 ACCESSION NUMBER: 0000702325-05-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041231 FILED AS OF DATE: 20050104 DATE AS OF CHANGE: 20050104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DIETRICH MARK M CENTRAL INDEX KEY: 0001199249 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10967 FILM NUMBER: 05508466 MAIL ADDRESS: STREET 1: 300 PARK BLVD STREET 2: SUITE 405 CITY: ITASCA STATE: IL ZIP: 60143 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 die276.xml X0202 4 2004-12-31 0 0000702325 FIRST MIDWEST BANCORP INC FMBI 0001199249 DIETRICH MARK M 300 PARK BOULEVARD, SUITE 400 ITASCA IL 60143 0 1 0 0 EVP, First Midwest Bank Phantom Stock under NQ Retirement Plan 2004-12-31 4 A 0 261 36.4160 A Common Stock 261 1248 D Shares of phantom stock in the NQ Retirement Plan have a 1-for-1 conversion ratio. Between May 21, 2004 and January 4, 2005 the reporting person acquired 261 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 December 31, 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 May 21, 2004 and January 4, 2005 the reporting person acquired 12 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 2005-01-04 -----END PRIVACY-ENHANCED MESSAGE-----