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
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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*
DOSLAND MICHAEL W

(Last) (First) (Middle)
1708 JENNIFER COURT

(Street)
ONALASKA WI 54650

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FIRST FEDERAL CAPITAL CORP [ FTFC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP - CFO
3. Date of Earliest Transaction (Month/Day/Year)
12/18/2003
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
FTFC COMMON STOCK 12/18/2003 M 3,000 A $14.75 33,088 D
FTFC COMMON STOCK 14,187 I 401(K), SELF
FTFC COMMON STOCK 1,422 I 401(K), WIFE
FTFC COMMON STOCK 11,259 I ESOP, SELF
FTFC COMMON STOCK 3,352 I ESOP, WIFE
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
INCENTIVE STOCK OPTIONS $14 04/20/2002 04/20/2009 FTFC COMMON STOCK 0 7,100 D
COMPENSATORU STOCK OPTIONS $14 (1) 04/20/2009 FTFC COMMON STOCK 0 2,900 D
INCENTIVE STOCK OPTIONS $14.06 12/18/2003 J(3) V 0 (2) 04/24/2011 FTFC COMMON STOCK 0 $0 13,200 D
COMPENSATORY STOCK OPTIONS $14.06 12/18/2003 J(3) V 0 04/24/2002 04/24/2011 FTFC COMMON STOCK 0 $0 6,600 D
INCENTIVE STOCK OPTIONS $14.75 12/18/2003 M 3,000 (4) 01/27/2008 FTFC COMMON STOCK 0 $0 6,000 D
Explanation of Responses:
1. Exerciseable in installments: 967 shares 04/20/2000; 967 Shares 04/20/2001; 966 shares 04/20/2002.
2. Exerciseable in installments: 6,600 shares 04/24/2003 and 6,600 shares 04/24/2004.
3. This is a voluntary filing for Mr. Dosland to correct a recordkeeping error on a previously reported option award; this corrections results in new change in Mr. Dosland's total number of derivative shares.
4. Exerciseable in installments: 3,333 shares 01/27/1999; 3,333 shares 01/27/2000; and 3,334 shares 01/27/2001.
Remarks:
MICHAEL W DOSLAND 12/19/2003
** 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.
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