-----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, S81X55HTOnEuqgVyWKHFeL3fF59s3B/v2b5vSUlqFVDVx/YK9rA3ut75PSraBqul se5pYvqSyuol11yLqPXaeg== 0000702325-05-000137.txt : 20050919 0000702325-05-000137.hdr.sgml : 20050919 20050919113546 ACCESSION NUMBER: 0000702325-05-000137 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050916 FILED AS OF DATE: 20050919 DATE AS OF CHANGE: 20050919 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: ONE PIERCE PLACE STREET 2: SUITE 1500 CITY: ITASCA STATE: IL ZIP: 60143 BUSINESS PHONE: 6308757450 MAIL ADDRESS: STREET 1: ONE PIERCE PLACE STREET 2: SUITE 1500 CITY: ITASCA STATE: IL ZIP: 60143 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: 051090592 BUSINESS ADDRESS: STREET 1: FIRST MIDWEST BANCORP INC STREET 2: 300 PARK BLVD SUITE 400 CITY: ITASCA STATE: IL ZIP: 60143 BUSINESS PHONE: 6308757450 4 1 bel369.xml X0202 4 2005-09-16 0 0000702325 FIRST MIDWEST BANCORP INC FMBI 0001279182 KENT S BELASCO ONE PIERCE PLACE, SUITE 1500 ITASCA IL 60143 0 1 0 0 EVP, Chief Information Officer Phantom Stock under NQ Retirement Plan 2005-09-16 4 A 0 1 37.3300 A Common Stock 1 1137 D Shares of phantom stock in the NQ Retirement Plan have a 1-for-1 conversion ratio. Between September 7, 2005 and September 19, 2005 the reporting person acquired 1 share 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 September 16, 2005. 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. By: Donna L. Zodrow, Attorney-in-fact for 2005-09-19 -----END PRIVACY-ENHANCED MESSAGE-----