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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MILLETT MARK D 7575 W. JEFFERSON BLVD. FORT WAYNE, IN 46804 |
X | President and CEO |
Mark D. Millett | 11/26/2018 | |
**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) | Represents grant of restricted stock, in lieu of restricted stock units because of reporting person's age, for no consideration, and exempt from Section 16(b) by virtue of Rule 16b-3(d)(1) and (3). subject, however, to a two year holding period. |
(2) | Represents disposition to issuer to cover taxes payable upon issuance of shares reported in footnote (1), exempt pursuant to Rule 16b-3. |
(3) | Represents disposition to issuer to cover taxes payable upon vesting of previously issued and reported restricted stock units, exempt pursuant to Rule 16b-3. |
(4) | Represents disposition to issuer to cover taxes payable upon issuance of restricted shares required to be issued to reporting person by reason of his age, in advance of the otherwise applicable second year of the two-year vesting requirement of previously issued restricted stock units; subject however, to an additional one-year holding period. |