-----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, Tm7HcUJChQ+HqzsGOnm5nvVWdZD4TZsu1/7GhgzY18T1x1Tjl3EofQBxaeMjPoEL c5oeXD36pwqCbgMUdmS5LA== 0001179110-04-001565.txt : 20040122 0001179110-04-001565.hdr.sgml : 20040122 20040122125032 ACCESSION NUMBER: 0001179110-04-001565 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040122 FILED AS OF DATE: 20040122 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: EVERTS EDWARD H CENTRAL INDEX KEY: 0001184319 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15393 FILM NUMBER: 04537050 MAIL ADDRESS: STREET 1: 1398 CENTRAL AVE CITY: DUBUQUE STATE: IA ZIP: 52001 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HEARTLAND FINANCIAL USA INC CENTRAL INDEX KEY: 0000920112 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 421405748 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 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 edgar.xml FORM 4 - X0201 4 2004-01-22 0 0000920112 HEARTLAND FINANCIAL USA INC HTLF 0001184319 EVERTS EDWARD H 1398 CENTRAL AVE. DUBUQUE IA 52001 0 1 0 0 Senior Vice President Common Stock 62687.344 D Common Stock 105.615 I Daughter Common Stock 212.786 I Son Common Stock 11040 I IRA Common Stock 2322 I 401(k) Common Stock 300 I 401(k)-Wife Non-Qualified Stock Option (Right to Buy) 5.75 2006-02-05 Common Stock 24000 24000 D Non-Qualified Stock Option (Right to Buy 8.00 2007-01-02 Common Stock 24000 24000 D Non-Qualified Stock Option (Right to Buy 9.83 2008-01-02 Common Stock 24000 24000 D Non-Qualified Stock Option (Right to Buy 12.00 2009-01-02 Common Stock 18000 18000 D Non-Qualified Stock Option (Right to Buy 12.00 2010-01-17 Common Stock 4500 4500 D Non-Qualified Stock Option (Right to Buy 8.67 2011-06-01 Common Stock 3000 3000 D Non-Qualified Stock Option (Right to Buy 8.80 2012-01-15 Common Stock 2250 2250 D Non-Qualified Stock Option (Right to Buy 11.84 2013-01-21 Common Stock 4500 4500 D Non-Qualified Stock Option (Right To Buy) 19.48 2004-01-20 4 A 0 3000 0 A 2014-01-20 Common Stock 3000 3000 D The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed to be an admission that the reporting person is the benefical owner of such securities for purposes of Section 16 or for any other purpose. Represents shares held in a 401(k) account for reporting person's wife. Shares participate in a Dividend Reinvestment Plan. Represents options to buy granted under the Company's 1993 Stock Option Plan, a Rule 16(b)(3) plan, which options vest one-third per year beginning on the 3rd anniversary of date of grant. This figure reflects the 3 for 2 stock split declared by the Company on December 29, 2003. These shares reflect 865 shares issued December 31, 2003, pursuant to the Employee Stock Purchase Plan. /s/ Edward H. Everts 2004-01-22 -----END PRIVACY-ENHANCED MESSAGE-----