SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
WAKE JAMES G

(Last) (First) (Middle)
P. O. BOX 1104

(Street)
OSKALOOSA IA 52577

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MIDWESTONE FINANCIAL GROUP INC [ OSKY ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
05/13/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 05/13/2004 05/13/2004 S 6,678 D $17.5 349 D
Common Stock 223 I By Spouse
Common Stock 1,380 I By Corporation
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option $13.95 (1) 04/30/2007 Common Stock 2,242 2,242 D
Stock Option $22 (2) 04/30/2008 Common Stock 1,581 1,581 D
Stock Option $13.86 (3) 04/30/2012 Common Stock 1,212 1,212 D
Stock Option $16 (4) 04/30/2013 Common Stock 1,448 1,448 D
Stock Option $18.52 (5) 04/30/2014 Common Stock 1,379 1,379 D
Explanation of Responses:
1. Total stock options granted as of April 30, 1997 were 2,242, of which 33% were exercisable on or after 04/30/1998, 66% were exercisable on or after 04/30/1999, and 100% were exercisable on or after 04/30/2000.
2. Total stock options granted as of April 30, 1998 were 1,581, of which 33% were exercisable on or after 04/30/1999, 66% were exercisable on or after 04/30/2000, and 100% were exercisable on or after 04/30/2001.
3. Total stock options granted as of April 30, 2002 were 1,212, of which 33% were exercisable on or after 04/30/2003, 66% were exercisable on or after 04/30/2004, and 100% are exercisable on or after 04/30/2005.
4. Total stock options granted as of April 30, 2003 were 1,448, of which 33% were exercisable on or after 04/30/2004, 66% are exercisable on or after 04/30/2005, and 100% are exercisable on or after 04/30/2006.
5. Total stock options granted as of April 30, 2004 were 1,379, of which 33% are exercisable on or after 04/30/2005, 66% are exercisable on or after 04/30/2006, and 100% are exercisable on or after 04/30/2007.
Karen K. Binns, under Power of Attorney dated 06/19/03 05/13/2004
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** 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 is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.