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 27, 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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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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Non-Qualified Stock Option (right to buy) |
$15.50 |
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8/12/99 (1) |
8/12/08 |
Common Stock |
20,000 |
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16,000 Vested/Available for Exercise |
I |
By Company |
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Explanation of Responses:
(1) Options vest 20% per year on the anniversary date of the grant for five (5) years at which time the option is 100% vested. Optinee 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.
|
/s/ Gracia B. Bello |
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01/27/2003 |
** Signature of Reporting Person |
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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