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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 | ||||||||
Non-Qualified Stock Option (right to buy) | $ 22.725 | 12/17/2004 | M(1) | 1,027 | 07/04/2001 | 02/15/2005 | Common Stock | 1,027 | $ 22.725 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 34.93 | 12/17/2004 | M(2) | 1,188 | 12/17/2004 | 02/15/2005 | Common Stock | 1,188 | $ 34.93 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 36.365 | 12/17/2004 | A(6) | 642 | 01/15/2005 | 02/15/2005 | Common Stock | 642 | $ 0 | 642 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 36.365 | 12/17/2004 | A(6) | 1,142 | 01/15/2005 | 02/15/2005 | Common Stock | 1,142 | $ 0 | 1,142 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DIETRICH MARK M 300 PARK BOULEVARD, SUITE 400 ITASCA, IL 60143 |
EVP, First Midwest Bank |
By: Steven H. Shapiro, Attorney in-fact for | 12/20/2004 | |
**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) | The transaction represents the exercise of 1,027 stock options under the Omnibus Stock & Incentive Plan whereby 642 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 385 shares. |
(2) | The transaction represents the exercise of 1,188 stock options under the Omnibus Stock & Incentive Plan whereby 1,142 previously acquired shares were tendered as payment of the exercise price with the resulting value realized being deferred into the Nonqualified Gain Deferral Plan in the form of 46 shares. |
(3) | Between May 21, 2004 to December 17, 2004 the reporting person acquired 84 shares of the First Midwest common stock pursuant to the dividend reinvestment feature under the First Midwest Bancorp, Inc. Non-Qualified Gain Deferral Plan. The information in this report is based on a plan statement dated October 25, 2004. |
(4) | Between June 22, 2004 and December 17, 2004 the reporting person acquired 26 shares of First Midwest Bancorp, Inc. common stock under the First Midwest Bancorp, Inc. Savings and Profit Sharing Plan. The information in this report is based on a plan statement dated December 1, 2004. |
(5) | Between May 21, 2004 and December 17, 2004 the reporting person acquired 235 shares of First Midwest common stock pursuant to the dividend reinvestment feature under the First Midwest Bancorp, Inc. Savings and Profit Sharing Plan. The information in this report is based on a plan statement dated October 25, 2004. |
(6) | The transaction represents a reload stock option granted under the Omnibus Stock & Incentive Plan to replace the number of shares tendered in the option exercised on 12/17/04. |