-----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, LbK2hNu4VtFKkUJ/tH2VgAy8bBcx8uRSidw1fuYXPSUk4678AoVDQ6jNrR7/8EpD LpNxn41nVf/T+xxrwDRqww== 0000712534-02-000067.txt : 20020515 0000712534-02-000067.hdr.sgml : 20020515 20020515104306 ACCESSION NUMBER: 0000712534-02-000067 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020514 FILED AS OF DATE: 20020515 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FIRST MERCHANTS CORP CENTRAL INDEX KEY: 0000712534 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] IRS NUMBER: 351544218 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-17071 FILM NUMBER: 02648879 BUSINESS ADDRESS: STREET 1: 200 E JACKSON ST STREET 2: PO BOX 792 CITY: MUNCIE STATE: IN ZIP: 47308-0792 BUSINESS PHONE: 3177471500 MAIL ADDRESS: STREET 1: 200 EAST JACKSON STREET CITY: MUNCIE STATE: IN ZIP: 47305 COMPANY DATA: COMPANY CONFORMED NAME: JEFFARES ROBERT T CENTRAL INDEX KEY: 0001041438 DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 133 N 4TH ST CITY: LAFAYETTE STATE: IN ZIP: 47902 BUSINESS PHONE: 3174237100 MAIL ADDRESS: STREET 1: 133 N 4TH ST CITY: LAFAYETTE STATE: IN ZIP: 47902 3 1 f3rtj0502.txt FORM 3 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 ________________________________________________________________________________ 1. Name and Address of Reporting Person* Jeffares Robert T. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 531 Pawnee Circle - -------------------------------------------------------------------------------- (Street) West Lafayette, Indiana 47906 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Date of Event Requiring Statement (Month/Day/Year) 05/14/02 ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ###-##-#### ________________________________________________________________________________ 4. Issuer Name and Ticker or Trading Symbol First Merchants Corporation (FRME) ________________________________________________________________________________ 5. Relationship of Reporting Person to Issuer (Check all applicable) [x] Director [_] 10% Owner [_] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 6. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [x] Form Filed by One Reporting Person [_] Form Filed by More than One Reporting Person ================================================================================ Table I -- Non-Derivative Securities Beneficially Owned ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3,973 D Jt. Spouse - Olga C. - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,495 D R.T. Jeffares TTEE, R.T. Jeffares Trust U/A (03/11/80) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 2,519 I Spouse - Olga C. - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,831* I Adult - Stepdaughter - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,831* I Adult - Stepson - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print of Type Responses) (Over) FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date --------------------------------- 4. Conver- Security: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: * Reporting person disclaims beneficial interest in said securities. /s/ Robert T. Jeffares May 15, 2002 - --------------------------------------------- ----------------------- **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. (Print of Type Responses) Page 2 -----END PRIVACY-ENHANCED MESSAGE-----