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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Option (Right to Buy) | $ 9.34 | 01/22/2010 | 01/22/2019 | Common Stock | 500 | 500 | I | By Spouse | |||||||
Stock Option (Right to Buy) | $ 16.69 | 01/21/2014 | M | 500 | 04/01/2009 | 04/01/2018 | Common Stock | 500 | $ 0 | 0 | I | By Spouse |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
POTHOVEN JOHN P 102 S. CLINTON STREET P.O. BOX 1700 IOWA CITY, IA 52244-1700 |
X |
Kenneth R. Urmie, under Power of Attorney dated January 22, 2009 | 01/24/2014 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Registered to self as custodian for minor grandchild under Uniform Transfers to Minors Act. The reporting person disclaims beneficial ownership of these shares, and this report shall not be deemed an admission that the reporting person is the beneficial owner of these shares for purposes of Section 16 or for any other purpose. |
(2) | Restricted Stock Units withheld to pay payroll taxes due upon vesting and issuance of Restricted Stock Units shares on January 18, 2014. |
(3) | Restricted Stock Units withheld to pay payroll taxes due upon vesting and issuance of Restricted Stock Units shares on January 21, 2014. |
(4) | Shares held in the MidWestOne Financial Group, Inc. Employee Stock Ownership Plan as of December 31, 2013. Shares increased by 7 shares since the date of the reporting person's last filing due to additional shares allocated to the reporting person's ESOP account. |
Remarks: The purpose of this amended Form 4 is to restore the Indirect custodial holding of 300 shares that was inadvertantly excluded from the original filing. The shares moved from a registered account to a street name account. |