-----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, P4n0X3B638v3Bh4ztVKBTxN62elJ87PJDzSpB6jCh7JNmkxGPjY5Gl/Q0LDQjWB1 cjWxM+VRkdCsmSZxZFZoOg== 0000920112-03-000005.txt : 20030123 0000920112-03-000005.hdr.sgml : 20030123 20030123105202 ACCESSION NUMBER: 0000920112-03-000005 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030121 FILED AS OF DATE: 20030123 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: PECKOSH PAUL J CENTRAL INDEX KEY: 0001184328 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 MAIL ADDRESS: STREET 1: 1398 CENTRAL AVE CITY: DUBUQUE STATE: IA ZIP: 52001 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: HEARTLAND FINANCIAL USA INC CENTRAL INDEX KEY: 0000920112 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 421405748 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15393 FILM NUMBER: 03521748 BUSINESS ADDRESS: STREET 1: 1398 CENTRAL AVE CITY: DUBUQUE STATE: IA ZIP: 52001 BUSINESS PHONE: 5635892000 MAIL ADDRESS: STREET 1: 1398 CENTRAL AVE CITY: DUBUQUE STATE: IA ZIP: 52001 4 1 f4pjp012103.txt FORM 4 PAUL PECKOSH U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [_] Check 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* Peckosh Paul J - -------------------------------------------------------------------------------- (Last) (First) (Middle) 1090 Langworthy St. - -------------------------------------------------------------------------------- (Street) Dubuque IA 52001 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Heartland Financial USA, Inc. HTLF ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year January 21, 2003 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) Senior Vice President, Trust ________________________________________________________________________________ 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 Acquired, Disposed of, or Beneficially Owned ================================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/31/02 A 534 A 12.80 47,913 D(2) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,632 I 401(k) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,600 I By Spouse(3) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 3,856 I IRA - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Response) (Over) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option Common (Right to Buy) 8.62 (1) 2-05-2006 Stock 12,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option Common (Right to Buy) 12.00 (1) 1-02-2007 Stock 12,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option Common (Right to Buy) 14.75 (1) 1-02-2008 Stock 12,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option Common (Right to Buy) 18.00 (1) 1-02-2009 Stock 6,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option Common (Right to Buy) 18.00 (1) 1-17-2010 Stock 1,500 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option Common (Right to Buy) 13.00 (1) 6-01-2011 Stock 500 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option Common (Right to Buy) 13.20 (1) 1-15-2012 Stock 500 D - ------------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option Common (Right to Buy) 17.76 1-21-03 A V 2,000 (1) 1-21-2013 Stock 2,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: /s/Paul J. Peckosh 1/21/03 - --------------------------------------------- ----------------------- **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. Page 2 -----END PRIVACY-ENHANCED MESSAGE-----