FORM 4
Check
this box if no longer subject to Section 16.
Form 4 or Form 5 obligations may continue. |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
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OMB APPROVAL |
OMB
Number: 3235-0287 |
1. Name and Address of Reporting Person *
(Last)
(First)
(Middle)
(Street)
(City)
(State) (Zip)
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2. Issuer Name and Ticker Mid-State Bancshares MDST
3. I.R.S.
Identification |
4. Statement for January 24, 2003
N/A / N/A |
6. Relationship of Reporting Person(s) to Issuer (Check
all applicable) X Director
10% Owner
Officer (give title below)
Other (specify below)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security |
2. Transaction Date
(Month/Day/ |
2A. Deemed Execution Date,
if any (Month/Day/ |
3. Transaction Code |
4. Securities Acquired (A)
or Disposed of (D) |
5. Amount of Securities
Beneficially Owned Following Reported Transaction(s) |
6. Ownership Form: Direct
(D) or Indirect (I) |
7. Nature of Indirect
Beneficial Ownership |
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Code |
V |
Amount |
(A) or (D) |
Price |
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Common Stock |
12/31/02 |
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P |
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25.98191 Shrs |
A |
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200,086.026360 |
D/401(k) Plan |
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Common Stock |
01/23/03 |
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P |
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27.98253 Shrs |
A |
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200,114.008890 |
D/401(k) Plan |
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Table II - Derivative Securities Acquired, Disposed of, or
Beneficially Owned |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security |
3. Transaction Date |
3A. Deemed Execution Date,
if any (Month/Day/ |
4. Transaction Code (Instr. 8) |
5. Number of Derivative
Securities Acquired (A) or Disposed of (D) |
6. Date Exercisable and
Expiration Date |
7. Title and Amount of
Underlying Securities |
8. Price of Derivative
Security |
9. Number of Derivative
Securities Beneficially Owned Following Reported Transaction(s) |
10. Ownership Form of
Derivative Securities: Direct (D) or Indirect (I) |
11. Nature of Indirect
Beneficial Ownership |
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Code |
V |
(A) |
(D) |
Date |
Expiration |
Title |
Amount or Number of Shares |
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Incentive Stock Option (right to buy) |
$5.3750 |
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8/14/99 (2) |
7/10/06 |
Common Stock |
33,488 |
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33,488 Vested/Available to Exercise |
I |
By Company |
Incentive Stock Option (right to buy) |
$15.50 |
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8/12/99 (2) |
8/12/08 |
Common Stock |
20,000 |
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16,000 Vested/Available for Exercise |
I |
By Company |
Incentive Stock Option (right to buy) (1) |
$17.9350 |
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7/14/00 (2) |
7/14/09 |
Common Stock |
10,030 |
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2,338 Vested/Available for Exercise |
I |
By Company |
Non-Qualified Stock Option (right to buy) |
$17.9350 |
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7/14/00 (2) |
7/14/09 |
Common Stock |
89,970 |
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57,662 Vested/Available for Exercise |
I |
By Company |
Incentive Stock Option (right to buy) (3) |
$16.6250 |
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1/10/02 (2) |
1/10/11 |
Common Stock |
12,028 |
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0 Vested until 1/10/05 |
I |
By Company |
Non-Qualified Stock Option (right to buy) |
$16.6250 |
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1/10/02 (2) |
1/10/11 |
Common Stock |
87,972 |
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20,000 Vested/Available for Exercise |
I |
By Company |
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Explanation of Responses:
(1) 100,000 shares granted as an ISO under the 1996 Stock Option Plan. Due to the $100K limitation, remaining 89,970 shares were issued and treated as a non-qualified stock option.
(2) Options vest 20% per year on the anniversary date of the grant for five (5) years at which time the option is 100% vested. Optionee has another five (5) years from the five (5) year "100% vesting" anniversary date to exercise the shares in accordance with the terms and conditions of the 1996 Stock Option Plan.
(3) 100,000 shares granted as an ISO under the 1996 Stock Option Plan. Due to the $100K limitation, remaining 87,972 shares were issued and treated as a non-qualified stock option.
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/s/ Carrol R. Pruett ** Signature of Reporting Person |
01/24/2003 Date |
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Reminder: Report on a separate
line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
http://www.sec.gov/divisions/corpfin/forms/form4.htm
Last update: 09/05/2002