-----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, DBcvWtL1mmRx5jy29kzIVz/Ugn/dX2rYBwRj1rBLlQiYRuGYoWIiUOV7L3N8FrWx 19G6W3RHLykfgd+LWbaRpQ== 0000712534-04-000022.txt : 20040203 0000712534-04-000022.hdr.sgml : 20040203 20040203140101 ACCESSION NUMBER: 0000712534-04-000022 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040130 FILED AS OF DATE: 20040203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HELMS LARRY R CENTRAL INDEX KEY: 0001012946 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-17071 FILM NUMBER: 04562202 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 ISSUER: 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 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 4 1 f4lrh0204_ex.xml X0201 4 2004-01-30 0 0000712534 FIRST MERCHANTS CORP FRME 0001012946 HELMS LARRY R 200 E JACKSON ST PO BOX 792 MUNCIE IN 47308-0792 0 1 0 1 Senior Vice President Secretary & General Counsel Deferred Stock Units 2004-01-30 4 A 0 164.96 25.54 A 2006-01-30 2006-01-30 Common Stock 164.96 827.93 D Conversion Price of Derivative Security is 1 for 1 Employee Stock Option-Right to Buy equals 42,960 shares. Common Stock Owned Direct equals 22,789 shares. On August 12, 2003, the Board of Directors of First Merchants Corporation declared a stock dividend payable to all holders of record of common stock on August 29, 2003 of one share of common stock for each 20 shares of common stock outstanding to be distributed on September 12, 2003. Fractional shares were distributed in cash. Pursuant to anti-dilution provisions of First Merchants Corporation's various stock option plans options previously reported were also adjusted to reflect the stock divi dend. Larry R. Helms (Confirming Statement on File) 2004-02-03 -----END PRIVACY-ENHANCED MESSAGE-----