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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 | |
BUSSE KEITH E 7575 W. JEFFERSON BLVD. FORT WAYNE, IN 46804 |
X | Chairman and CEO |
Keith E. Busse | 12/17/2009 | |
**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) | Reflects corrected aggregate share total carried over from Column 5 of Reporting Person's Form 4, filed December 15, 2009, (a) for the effect of Issuer's March 19, 2008 2:1 stock split inadvertently not previously applied to certain unvested portions of prior stock bonus awards, and (b) to properly reflect a portion of Reporting Person's deemed holdings as "Indirect," as more fully explained in footnote (2). |
(2) | Reflects shares Reporting Person previously contributed to and which are held by the Busse Family Investment Company, LLC, formed April 12, 2007. Reporting Person holds no sole or shared voting or investment power over such shares, such authority being vested exclusively in a board of managers of which the Reporting Person is not a member. Reporting Person disclaims all beneficial ownership of such shares, which are nonetheless being reported herein because of Reporting Person's possible pecuniary interest in a portion thereof. |
(3) | Corrected to add 19,120 shares to total in Column 5 to reflect the 19,120 shares acquired through exercise of an exempt stock option, described in Mr. Busse's Form 4 filed December 15, 2009, but inadvertently omitted from the share total in Mr. Busse's Form 4 filed December 16, 2009. |