FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
|
OMB APPROVAL
|
|
1. Name and Address of Reporting Person* |
2. Issuer Name and Ticker or Trading Symbol |
6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ____Director _____10% owner__X_Officer (give title below) _____Other (Specify below) TITLE VICE PRESIDENT - ASSISTANT GENERAL AUDITOR |
||||||||
|
3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) |
4. Statement for |
||||||||
|
5. If Amendment, Date of Original (Month/Day/Year) |
7. Individual or Joint Group Filing (Check Applicable Line) |
||||||||
Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
||||||||||
1. Title of Security (Instr. 3) |
2. Transaction Date |
2A. Deemed Execution Date, if any (Month/ |
3. Transaction Code |
4. Securities Acquired (A) |
5. Amount of Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 3 and 4) |
6. Owner- ship Form: Direct (D) or Indirect (I) |
7. Nature of Indirect Beneficial Ownership |
|||
|
|
|
||||||||
COMMON STOCK |
25 |
I |
BY 401(K) |
|||||||
|
||||||||||
|
||||||||||
|
||||||||||
|
||||||||||
|
||||||||||
|
||||||||||
|
||||||||||
|
||||||||||
|
If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
Page 1 of 3 |
FORM 5 (continued) |
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 Deri- vative Security |
3. Trans- action Date (Month/ Day/ Year) |
3A. Deemed Execution Date, if any (Month/ |
4. Trans- action 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 |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Month (Instr. 4) |
10. Owner- ship Form of Derivative Security: Direct (D) or Indirect (I) |
11. Nature of Indirect Beneficial Owner- ship (Instr. 4) |
|||
|
|
|
|
|
Amount or Number of Shares |
|||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
Explanation of Responses: See continuation page(s) for footnotes
/S/ NANCY ROTH _________________________________________ |
1/23/2003 |
**Signature of Reporting Person |
Date |
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. |
Page 2 of 3 |
FORM 5 (continued) |
|
ROTH, NANCY |
Irwin Financial Corporation (IFC) |
500 Washington Street |
12/31/2002 |
Columbus IN 47201 |
FOOTNOTES:
1. Includes 21 additional shares acquired through participation in the Irwin Financial Corporation Employees' Savings Plan (401(k) Plan). Shares noted are as of 12/31/02. The number reported is the nearest whole number. |
Page 3 of 3 |