Statement of Changes in Beneficial Ownership (4)
December 12 2017 - 10:24AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Mefford Jeffrey S.
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2. Issuer Name
and
Ticker or Trading Symbol
Midland States Bancorp, Inc.
[
MSBI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
EVP-Banking
/
Midland States Bank
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(Last)
(First)
(Middle)
1201 NETWORK CENTRE DR.
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3. Date of Earliest Transaction
(MM/DD/YYYY)
12/10/2017
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(Street)
EFFINGHAM, IL 62401
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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12/10/2017
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F
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180
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D
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$31.82
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21787.4580
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Option (right to buy)
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$18.16
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(1)
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12/6/2020
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Common Stock
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9520
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9520
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D
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Option (right to buy)
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$16
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(2)
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12/13/2022
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Common Stock
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5500
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5500
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D
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Option (right to buy)
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$23
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(3)
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11/3/2025
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Common Stock
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10702
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10702
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D
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Option (right to buy)
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$16.59
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(4)
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12/10/2023
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Common Stock
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6661
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6661
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D
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Option (right to buy)
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$21
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(5)
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12/2/2024
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Common Stock
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7885
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7885
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D
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Option (right to buy)
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$14.70
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(6)
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5/5/2018
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Common Stock
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7000
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7000
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D
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Option (right to buy)
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$15.20
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(7)
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12/31/2019
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Common Stock
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7500
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7500
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D
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Option (right to buy)
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$14.75
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(8)
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12/16/2021
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Common Stock
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5559
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5559
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D
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Option (right to buy)
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$11.75
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(9)
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6/22/2019
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Common Stock
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12756
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12756
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D
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Option (right to buy)
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$18
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(10)
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8/5/2024
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Common Stock
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10000
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10000
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D
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Option (right to buy)
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$28.59
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(11)
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11/16/2026
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Common Stock
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5341
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5341
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D
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Explanation of Responses:
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(1)
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These options vest in four equal annual installments beginning one year after the 12/06/2010 date of grant.
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(2)
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These options vest in four equal annual installments beginning one year after the 12/13/2012 date of grant.
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(3)
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These options vest in four equal annual installments beginning one year after the 11/03/2015 date of grant.
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(4)
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These options vest in four equal annual installments beginning one year after the 12/10/2013 date of grant.
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(5)
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These options vest in four equal annual installments beginning one year after the 12/02/2014 date of grant.
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(6)
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These options vest in four equal annual installments beginning one year after the 05/05/2008 date of grant.
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(7)
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These options vest in four equal annual installments beginning one year after the 12/31/2009 date of grant.
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(8)
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These options vest in four equal annual installments beginning one year after the 12/16/2011 date of grant.
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(9)
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These options vest in four equal annual installments beginning one year after the 06/22/2009 date of grant.
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(10)
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Such options will vest on 12/31/2017 if specific performance metrics are satisfied, as determined by the Board of Directors.
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(11)
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These options vest in four equal annual installments beginning one year after the 11/16/2016 date of grant.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Mefford Jeffrey S.
1201 NETWORK CENTRE DR.
EFFINGHAM, IL 62401
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EVP-Banking
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Midland States Bank
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Signatures
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/s/ Mefford Jeffrey S
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12/12/2017
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**
Signature of Reporting Person
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Date
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/s/ Douglas J. Tucker, attorney-in-fact
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12/12/2017
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**
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.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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