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Filed by
MutualFirst
Financial,
Inc.
Commission File No.: 000-27905
Pursuant to Rule 425 under the Securities Act of
1933
Subject Company: MFB Corp.
Commission File No.:
001-12279
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MutualFirst
Financial, Inc.
(“
MutualFirst
”) has
filed a registration statement on Form S-4 with the Securities and Exchange
Commission (the “SEC”), which was declared effective by the SEC, in connection
with the proposed merger of MFB Corp. (“MFB”) with and into MutualFirst
Acquisition Corp., a wholly owned subsidiary of
MutualFirst
. The
registration statement includes a joint proxy statement of
MutualFirst
and MFB that also
constitutes a prospectus of
MutualFirst
(the “joint proxy
statement/prospectus”), which has been sent to the stockholders of
MutualFirst
and MFB.
Stockholders are advised to read the joint proxy statement/prospectus, which is
contained within the amended Registration Statement on Form S-4 filed by
MutualFirst
with the SEC on
April 25, 2008, because it contains important information about
MutualFirst
, MFB and the
proposed transaction. The joint proxy statement/prospectus, and other
documents relating to the merger filed by
MutualFirst
and MFB, can be
obtained free of charge from the SEC’s website at www.sec.gov. These
documents also can be obtained free of charge by accessing
MutualFirst
’s website at
www.mfsbank.com. Alternatively, these documents can be obtained free of
charge from
MutualFirst
upon written request to
MutualFirst
Financial, Inc.,
Secretary, 110 E. Charles St., Muncie, Indiana 47305 or by calling (765)
747-2800, or from MFB, upon written request to MFB Corp., Secretary, 4100 Edison
Lakes Parkway, Mishawaka, Indiana 46545 or by calling (574)
277-4200.
Set
forth below are materials being sent to MFB stockholders for the exercise of
their election rights as to the form of consideration they would like to receive
for their MFB shares in the
MutualFirst
/MFB merger,
subject to the proration and allocation provisions of the merger
agreement. As specified in these materials, the deadline for the proper
exercise of election rights is 5:00 p.m. Central time, on July 11,
2008.
[
MUTUALFIRST
FINANCIAL
LOGO] [MFB
CORP. LOGO]
June 6,
2008
Dear MFB
Stockholder:
In
connection with the proposed merger of
MutualFirst
Financial, Inc.
and MFB Corp., we are pleased to offer you the opportunity to indicate your
preference as to the form of consideration you will receive for your shares of
MFB common stock. Subject to the proration provisions of the merger
agreement described below (which may result in adjustments to your election),
you have the right to elect to receive, for each share of MFB common stock that
you own, either 2.59 shares of
MutualFirst
common stock,
with cash paid in lieu of fractional share interests (the “stock
consideration”), or $41.00 in cash (the “cash consideration”). You
may specify different elections with respect to different shares that you hold
(if, for example, you hold 100 shares of MFB common stock, you can make a stock
election with respect to 50 shares and a cash election with respect to 50
shares). For the stock consideration, the amount of cash to be paid
in lieu of each fractional share interest will be equal to the fraction
multiplied by the average of the closing prices of
MutualFirst
common stock for
the five trading days ending on the second trading day before the date of
completion of the merger.
Because
the exchange ratio for the stock consideration is fixed at 2.59
MutualFirst
shares for each
MFB share, the value of the stock consideration will fluctuate with the market
price of
MutualFirst
common stock. Accordingly, at the time of the merger, the per share
value of the stock consideration may be greater or lesser than the per share
value of the cash consideration. On May 29, 2008, the closing price
of
MutualFirst
common
stock was $9.96, making the value of 2.59 shares of
MutualFirst
common stock
equal to $25.80 on that date, as compared to $41.00 for the cash
consideration. You should obtain a current price quotation for
MutualFirst
common
stock.
MutualFirst
common stock trades on the NASDAQ Global Market under the symbol
“MFSF.” Please note that if you hold your MFB shares through a bank,
broker or other nominee, the stock and/or cash consideration you are entitled to
receive in the merger will be paid to your bank, broker or other nominee first,
and then distributed to you in accordance with their procedures.
The merger agreement provides that 80%
of the shares of MFB common stock outstanding immediately prior to the effective
time of the merger will be exchanged for the stock consideration, with the
remaining 20% of the outstanding MFB shares exchanged for the cash
consideration. As a result, if the holders of more than 80% of the
outstanding MFB shares make valid elections to receive the stock consideration
or if the holders of more than 20% of the outstanding MFB shares make valid
elections to receive the cash consideration, those MFB stockholders electing the
over-subscribed form of consideration will have the over-subscribed form of
consideration proportionately reduced and will receive a portion of their
consideration in the other form, despite their election.
Therefore, you might receive
MutualFirst
stock and/or cash in an amount that
is not consistent with your election, depending upon the elections of other MFB
stockholders.
For a description of the proration provisions of
the Merger Agreement, see “The Merger Agreement—Merger Consideration—Proration”
beginning on page 72 of the joint proxy statement-prospectus for the merger,
which was separately mailed to
MutualFirst
and MFB
stockholders on or about May 1, 2008.
Because
the federal income tax consequences of the merger to you will depend on whether
you receive stock, cash or a combination of both, you are urged to consult your
personal tax advisor prior to making your election.
Enclosed is a Stock/Cash Election
Form and Letter of Transmittal, which you must complete, sign and return with
your MFB stock certificate(s) to the exchange agent for the merger, Continental
Stock Transfer & Trust Company, in order to make an
election
. Also enclosed are answers to a number of frequently
asked questions about the merger and the election process.
Please use the enclosed envelope to
return your Stock/Cash Election Form and Letter of Transmittal and your stock
certificate(s)
. For your election to be effective, the exchange agent
must receive your Stock/Cash Election Form and Letter of Transmittal, together
with your MFB stock certificate(s)(or a Notice of Guaranteed Delivery, as
described in Instruction 15 to the Stock/Cash Election Form and Letter of
Transmittal),
NO LATER THAN
5:00 P.M., CENTRAL TIME, ON JULY 11, 2008
. Please follow the
instructions on the Stock/Cash Election Form and Letter of Transmittal and read
the answers to the frequently asked questions carefully. You do not
need to sign the back of your MFB stock certificate(s). You may
change or revoke your election at any time prior to the election deadline by
following the instructions in the Stock/Cash Election Form and Letter of
Transmittal.
If you hold any MFB shares through a
bank, broker or other nominee, you will instead need to follow the instructions
of the bank, broker or other nominee to make your election.
Be
sure to follow the instructions of your bank, broker or other nominee carefully,
as they may impose an earlier election deadline and/or procedures different from
those described above. You should contact your bank, broker or other
nominee if you have any questions regarding their instructions.
If you need assistance, please call
the information agent for the election and surrender of MFB shares, Regan &
Associates, Inc., at 800-737-3426
. If you do not make a timely and proper
election, the exchange agent will send you additional forms for the surrender of
your MFB stock certificate(s) after completion of the merger, and you will
receive
MutualFirst
common stock and/or cash in exchange for your shares depending on the timely and
proper elections of other MFB stockholders pursuant to the allocation provisions
of the merger agreement.
Your submission
of a Stock/Cash Election Form and Letter of Transmittal does NOT constitute a
vote on the merger agreement. In order to vote your MFB shares on the
merger agreement, you must complete, sign, date and return the proxy card
included with the joint proxy statement-prospectus previously mailed to you, or
attend the special meeting of MFB stockholders described in the joint proxy
statement-prospectus and vote in person at the meeting
.
Thank
you for your
prompt attention to this important matter.
Very
truly yours,
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/s/David
W. Heeter
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/s/
Charles J. Viater
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David
W. Heeter
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Charles
J. Viater
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President
and Chief Executive Officer
MutualFirst
Financial, Inc.
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President
and Chief Executive Officer
MFB Corp.
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STOCK/CASH
ELECTION FORM AND LETTER OF TRANSMITTAL
PURSUANT
TO THE AGREEMENT AND PLAN OF MERGER, DATED AS OF JANUARY 7, 2008,
BY
AND
AMONG
MUTUALFIRST
FINANCIAL, INC., MUTUALFIRST ACQUISITION CORP.
AND
MFB CORP.
TO
ACCOMPANY CERTIFICATES EVIDENCING SHARES OF COMMON STOCK, NO PAR
VALUE,
OF
MFB CORP.
Name(s)
and Address(es) of Registered Holder(s)
(Please
fill in exactly as Name(s) appear(s) on Certificate(s); if already filled
in, correct any errors )
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Certificate
Number(s)
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Number
of
Shares
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(If
additional space is needed, attach a
signed
schedule to this
document)
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TOTAL
SHARES
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THE
INSTRUCTIONS ACCOMPANYING THIS STOCK/CASH ELECTION FORM AND LETTER OF
TRANSMITTAL, ALONG WITH THE ACCOMPANYING “FREQUENTLY ASKED QUESTIONS,” SHOULD BE
READ CAREFULLY BEFORE THIS STOCK/CASH ELECTION FORM AND LETTER OF TRANSMITTAL IS
COMPLETED.
FAILURE
TO COMPLETE THE SUBSTITUTE FORM W-9 INCLUDED IN THIS STOCK/CASH ELECTION FORM
AND LETTER OF TRANSMITTAL MAY SUBJECT YOU TO BACKUP WITHHOLDING.
PLEASE
COMPLETE, SIGN AND MAIL OR DELIVER THIS STOCK/CASH ELECTION FORM AND LETTER OF
TRANSMITTAL, TOGETHER WITH THE CERTIFICATE(S) REPRESENTING YOUR SHARES OF MFB
CORP. COMMON STOCK (OR NOTICE OF GUARANTEED DELIVERY), TO THE EXCHANGE
AGENT:
CONTINENTAL
STOCK TRANSFER & TRUST COMPANY
By
Hand, Mail or Overnight Delivery:
Continental
Stock Transfer & Trust Company
Reorganization
Department
17
Battery Place, 8
th
Floor
New York,
New York 10004
Tel.:
(212) 509-4000 ext. 536
To assist you, REGAN & ASSOCIATES,
INC. has been retained as Information Agent for stockholder
inquiries.
If you have any
questions or need assistance, you are encouraged to contact the Information
Agent toll free, at (800) 737-3426.
The method of delivery of the
certificate(s) and other documents is at the option and risk of the owner
thereof. SEE INSTRUCTION 10.
THE ELECTION DEADLINE IS 5:00 P.M.,
CENTRAL TIME, ON JULY 11, 2008
. THIS STOCK/CASH ELECTION FORM
AND LETTER OF TRANSMITTAL MUST BE COMPLETED, SIGNED AND RECEIVED BY THE EXCHANGE
AGENT, ALONG WITH YOUR STOCK CERTIFICATE(S) (OR A NOTICE OF GUARANTEED DELIVERY
AS DESCRIBED HEREIN), NO LATER THAN THIS TIME.
IF YOUR MFB STOCK CERTIFICATE(S) HAS
(HAVE) BEEN LOST, STOLEN OR DESTROYED, CONTACT THE TRANSFER AGENT FOR MFB COMMON
STOCK, REGISTRAR & TRANSFER COMPANY, AT (800) 368-5948 AS SOON AS POSSIBLE
TO ARRANGE FOR THE REPLACEMENT OF YOUR LOST, STOLEN OR DESTROYED
CERTIFICATE(S). SEE INSTRUCTION 7.
IF YOU HAVE QUESTIONS REGARDING ANY
OTHER MATTER, PLEASE CONTACT THE INFORMATION AGENT AT (800)
737-3426.
PLEASE
NOTE THAT THIS STOCK/CASH ELECTION FORM IS NOT FOR CASTING YOUR VOTE AT THE JUNE
11, 2008 SPECIAL MEETING OF MFB STOCKHOLDERS. YOU MUST COMPLETE AND
RETURN THE PROXY CARD SENT TO YOU PREVIOUSLY IN ORDER TO VOTE AT THE
MEETING.
Pursuant
to the Agreement and Plan of Merger, dated as of January 7, 2008 (the “Merger
Agreement”), by and among
MutualFirst
Financial, Inc.
(“
MutualFirst
”),
MutualFirst Acquisition Corp., a wholly owned subsidiary of
MutualFirst
(“Acquisition
Corp.”), and MFB Corp. (“MFB”), you may elect the form of consideration that you
would like to receive for your shares of MFB common stock upon completion of the
merger of MFB into Acquisition Corp. Subject to the proration
provisions of the Merger Agreement described below (which may result in
adjustments to your election), you have the right to elect to receive, for each
share of MFB common stock that you own, either 2.59 shares of
MutualFirst
common stock,
with cash paid in lieu of fractional share interests (the “stock
consideration”), or $41.00 in cash (the “cash consideration”). You
may specify different elections with respect to different shares that you hold
(if, for example, you hold 100 shares of MFB common stock, you can make a stock
election with respect to 50 shares and a cash election with respect to 50
shares). Alternatively, you may indicate that you have no preference
as to the form of merger consideration that you will receive. For the
stock consideration, the amount of cash to be paid in lieu of each fractional
share interest will be equal to the fraction multiplied by the average of the
closing prices of
MutualFirst
common stock for
the five trading days ending on the second trading day before the date of
completion of the merger.
Because
the exchange ratio for the stock consideration is fixed at 2.59
MutualFirst
shares for each
MFB share, the value of the stock consideration will fluctuate with the market
price of
MutualFirst
common stock. Accordingly, at the time of the closing of the merger,
the per share value of the stock consideration may be greater or lesser than the
per share value of the cash consideration. On May 29, 2008, the
closing price of
MutualFirst
common stock was
$9.96, making the value of 2.59 shares of
MutualFirst
common stock
equal to $25.80 on that date, as compared to $41.00 for the cash
consideration. You should obtain a current price quotation for
MutualFirst
common
stock.
MutualFirst
common stock trades on the NASDAQ Global Market under the symbol
“MFSF.”
The
Merger Agreement provides that 80% of the shares of MFB common stock outstanding
immediately prior to the effective time of the merger will be exchanged for the
stock consideration, with the remaining 20% of the outstanding MFB shares
exchanged for the cash consideration. As a result, if the holders of
more than 80% of the outstanding MFB shares make valid elections to receive the
stock consideration or if the holders of more than 20% of the outstanding MFB
shares make valid elections to receive the cash consideration, those MFB
stockholders electing the over-subscribed form of consideration will have the
over-subscribed form of consideration proportionately reduced and will receive a
portion of their consideration in the other form, despite their
election.
Therefore,
you might receive
MutualFirst
stock and/or cash in an amount that
is not consistent with your election, depending upon the elections of other MFB
stockholders.
For a description of the proration provisions of
the Merger Agreement, see “The Merger Agreement—Merger Consideration—Proration”
beginning on page 72 of the joint proxy statement-prospectus for the merger,
which was separately mailed to
MutualFirst
and MFB
stockholders on or about May 1, 2008. The joint proxy
statement-prospectus is contained within the amended Registration Statement on
Form S-4 filed by
MutualFirst
with the
Securities and Exchange Commission on April 25, 2008, which can be retrieved by
accessing
MutualFirst’s
filings at the Securities and Exchange Commission’s website, at
www.sec.gov
.
Subject to the conditions and
limitations set forth in the Merger Agreement, the undersigned hereby elects to
receive the following as consideration for the undersigned’s shares of MFB
common stock:
CHECK
ONE BOX ONLY TO INDICATE YOUR ELECTION
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(1)
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Stock Election
-- All
shares of MFB common stock I own converted into the stock
consideration;
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or
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(2)
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Cash Election
-- All
shares of MFB common stock I own converted into the cash
consideration;
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or
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(3)
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Mixed Election
-- a
combination of stock and cash as
follows:
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_________
shares of MFB common stock converted into the stock consideration,
and
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_________
shares of MFB common stock converted into the cash
consideration.
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_________ Total
(cannot exceed the total number of MFB shares you own of
record).
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or
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(4)
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Non-Election
-- Your MFB shares will be deemed non-election shares
if:
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a.
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You
check this box, thereby indicating that you have no preference as to the
form of merger consideration that you will receive;
or
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b. No
choice is indicated above under (1), (2) or (3); or
c. More
than one choice is indicated above under (1), (2) and (3); or
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d.
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You
fail to follow the instructions on this Stock/Cash Election Form and
Letter of Transmittal (including submission of your MFB common stock
certificate(s)) or otherwise fail properly to make an election);
or
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e.
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A
completed Stock/Cash Election Form and Letter of Transmittal (including
submission of your MFB common stock certificate(s) or a Notice of
Guaranteed Delivery) is not actually received by the Exchange Agent by the
Election Deadline.
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If
your MFB shares are deemed non-election shares, you will receive the stock
consideration and/or the cash consideration as determined pursuant to the
allocation provisions of the Merger Agreement without regard to your
preferences.
Priority
Allocation
:
If you have made
a Stock Election or Mixed Election and wish to designate the priority in which
your MFB shares are to be allocated to the stock consideration in the event the
stock consideration is oversubscribed, please designate such priority below by
stock certificate number, with the MFB shares to be converted into the stock
consideration listed first. See Instruction 8.
Certificate No.
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Total No. of Shares
Represented
by Certificate
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The tax
consequences of the merger to you will depend on whether you receive
MutualFirst
stock, cash or a
combination of both for your MFB shares.
You should consult your
personal tax advisor prior to making an election and any priority
designation.
If you hold a single stock certificate that
evidences shares of MFB common stock acquired in different lots and wish to make
a priority designation, you should consult your personal tax advisor with regard
to the method of identifying particular lots for priority allocation to the
stock consideration.
TO
BE EFFECTIVE, THIS STOCK/CASH ELECTION FORM AND LETTER OF TRANSMITTAL MUST BE
PROPERLY COMPLETED, SIGNED AND DELIVERED TO THE EXCHANGE AGENT, TOGETHER WITH
THE CERTIFICATE(S) REPRESENTING YOUR SHARES OF MFB COMMON STOCK (OR A NOTICE OF
GUARANTEED DELIVERY, AS DESCRIBED HEREIN), AT THE ADDRESS ABOVE
PRIOR TO THE ELECTION
DEADLINE
.
The
undersigned represents that the undersigned has full authority to surrender
without restriction the certificate(s) representing shares of MFB common stock
for exchange. Please issue the new certificate for shares of
MutualFirst
common stock
and/or the check for cash in lieu of a fractional share interest or the cash
consideration in the name shown above to the above address unless instructions
are given under “Special Issuance/Payment Instructions” and/or “Special Delivery
Instructions” below.
YOU
MUST SIGN BELOW
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*
SIGNATURE(S) REQUIRED *
Signature(s)
of Registered Holder(s) or Agent
Must
be signed by the registered holder(s) EXACTLY as name(s)
appears(s) on stock certificate(s). If signature is by a trustee,
executor, administrator, guardian, attorney-in-fact, officer for a
corporation acting in a fiduciary or representative capacity, or other
person, please set forth full title. SEE INSTRUCTIONS 11 AND
12.
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SIGNATURE(S)
GUARANTEED (IF REQUIRED)
SEE INSTRUCTION
12.
Unless
the shares are tendered by the registered holder(s) of the common stock,
or for the account of a member of a Signature Guarantee Program, Stock
Exchange Medallion Program or New York Stock Exchange Medallion Signature
Program, your signature(s) must be guaranteed by an Eligible
Institution.
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__________________________________________
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__________________________________________
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__________________________________________
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__________________________________________
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__________________________________________
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__________________________________________
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Address
of Firm (Please Print)
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Date: ____________________
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SPECIAL
ISSUANCE/PAYMENT INSTRUCTIONS
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SPECIAL
DELIVERY INSTRUCTIONS
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Complete
ONLY if the new certificate for
MutualFirst
common
stock and/or check is to be issued in a name that differs from the name on
the surrendered certificate(s).
Issue
to:
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Complete
ONLY if the new certificate for
MutualFirst
common
stock and/or check is to be sent to an address other than the address
reflected above.
Mail
to:
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Name _____________________________________
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Name
_____________________________________
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Address
_____________________________________
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Address _____________________________________
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(Please
also complete Substitute Form W-9 on page 5 AND see instructions regarding
signature guarantee. SEE INSTRUCTIONS 12, 13 AND 14)
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SEE
INSTRUCTION 13
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ALSO:
SIGN AND PROVIDE YOUR TAX ID NUMBER IN SUBSTITUTE FORM W-9 ON PAGE 5 OF THIS
DOCUMENT.
AS A
RESULT OF COMPLETING AND SIGNING THIS STOCK/CASH ELECTION FORM AND LETTER OF
TRANSMITTAL IN ACCORDANCE WITH THE INSTRUCTIONS, YOU WILL NOT NEED TO SIGN THE
BACK OF YOUR MFB STOCK CERTIFICATE(S).
IMPORTANT
TAX INFORMATION
Under
United States federal income tax law, a non-exempt stockholder of MFB is
required to provide the Exchange Agent with such stockholder’s correct Taxpayer
Identification Number (TIN) on the Substitute Form W-9 below. You
must provide your TIN and complete the Substitute Form W-9 below regardless of
the form of merger consideration you elect. If the certificate(s) are
in more than one name or are not in the name of the actual owner, consult the
enclosed Substitute Form W-9 guidelines for additional guidance on which number
to report. FAILURE TO PROVIDE THE INFORMATION ON THE FORM MAY SUBJECT THE
SURRENDERING STOCKHOLDER TO 28% FEDERAL INCOME TAX WITHHOLDING ON THE PAYMENT OF
ANY CASH. If the Exchange Agent is not provided with a TIN before payment is
made, the Exchange Agent will withhold 28% on all payments to such surrendering
stockholders of any cash due for their MFB shares. Please review the enclosed
Guidelines for Certification of Taxpayer Identification Number on Substitute
Form W-9 for additional details on which TIN to give the Exchange
Agent.
PAYER’S
NAME:
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Continental
Stock Transfer & Trust Company
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SUBSTITUTE
FORM W-9
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Part
1-PLEASE PROVIDE YOUR TIN ON THE LINE AT RIGHT AND CERTIFY BY SIGNING AND
DATING BELOW.
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TIN __________________________
Social
Security Number or
Employer
Identification Number
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_____________________________________________________________________________________
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Department
of the Treasury
Internal
Revenue Service
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Name
(Please Print)
__________________________________________
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Address
__________________________________________
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Part
2-For Payees (i.e., corporations
and
certain foreign individuals)
exempt
from backup withholding,
please
write "exempt"____________
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Payer’s
Request for Taxpayer
Identification
Number ("TIN") and Certification
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Part
3-CERTIFICATION. UNDER PENALTIES OF PERJURY, I CERTIFY THAT (1)
the number shown on this form is my correct taxpayer identification number
(or I am waiting for a number to be issued to me), (2) I am not subject to
backup withholding because (a) I am exempt from backup withholding, or
(b) I have not been notified by the Internal Revenue Service
(the “IRS”) that I am subject to backup withholding as a result of a
failure to report all interest or dividends or (c) the IRS has notified me
that I am no longer subject to backup withholding, (3) I am a U.S. citizen
or other U.S. person, and (4) all other information provided on this form
is true, correct and complete.
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SIGNATURE _________________________
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DATE _______________________
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You
must cross out item (2) above if you have been notified by the IRS that
you are currently subject to backup withholding because you have failed to
report all interest or dividends on your tax return. However,
if after being notified by the IRS that you were subject to backup
withholding, you received another notification from the IRS that you are
no longer subject to backup withholding, do not cross out item
(2).
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INSTRUCTIONS
(Please
read carefully the instructions below)
If you have any
questions, please call the Information Agent
,
Regan &
Associates, Inc., at (800) 737-3426.
1. ELECTION
DEADLINE: For any election contained herein to be considered, this Stock/Cash
Election Form and Letter of Transmittal, properly completed and signed, together
with the related MFB common stock certificate(s),
MUST BE RECEIVED BY THE EXCHANGE
AGENT AT THE ADDRESS ON THE FRONT OF THIS STOCK/CASH ELECTION FORM AND LETTER OF
TRANSMITTAL NO LATER THAN 5:00 P.M., CENTRAL TIME, ON JULY 11, 2008
. If
you are surrendering your MFB shares via Notice of Guaranteed Delivery, see
Instruction 15 below.
MutualFirst
has the
discretion, which it may delegate to the Exchange Agent, to determine whether
any Stock/Cash Election Form and Letter of Transmittal is received on a timely
basis and whether a Stock/Cash Election Form and Letter of Transmittal has been
properly completed.
2. DESCRIPTION
OF CERTIFICATE(S): Insert in the box at the top of this Stock/Cash Election Form
and Letter of Transmittal the certificate number(s) of the MFB common stock
certificate(s) that you are surrendering herewith, the number of shares
represented by each certificate, and the name(s) and address(es) of the
registered owners of such certificate(s). If the space provided is
insufficient, attach a separate sheet listing this information.
3. ELECTION
OPTIONS: On page 3 of this Stock/Cash Election Form and Letter of Transmittal,
you may indicate whether you would like to receive, in exchange for your shares
of MFB common stock, the stock consideration, the cash consideration or a
combination of the stock consideration and the cash
consideration. Alternatively, you may indicate that you have no
preference as to the form of merger consideration that you will
receive. Mark only one selection. The Merger Agreement
provides that 80% of the shares of MFB common stock outstanding immediately
prior to the effective time of the merger will be exchanged for the stock
consideration, with the remaining 20% of the outstanding MFB shares exchanged
for the cash consideration. Therefore, you might receive
MutualFirst
stock and/or cash
in an amount that is not consistent with your election, depending upon the
elections of other MFB stockholders.
4. NOMINEES:
Any record holder of shares of MFB common stock who is a nominee may submit one
or more Stock/Cash Election Forms and Letters of Transmittal indicating on the
form or forms a combination of elections covering up to the aggregate number of
shares of MFB common stock owned by such record holder. However, upon
the request of
MutualFirst
, such record
holders will be required to certify to the satisfaction of
MutualFirst
that such record
holder holds such shares of MFB common stock as nominee for the beneficial
owners of such shares.
5. REVOCATION
OR CHANGE OF STOCK/CASH ELECTION FORM: Any Stock/Cash Election Form and Letter
of Transmittal may be revoked or changed by written notice from the person
submitting such form to the Exchange Agent, but to be effective such notice must
be received by the Exchange Agent at or prior to the Election
Deadline.
MutualFirst
will have the
discretion, which it may delegate to the Exchange Agent, to determine whether
any revocation or change is received on a timely basis and whether any such
revocation or change has been properly made.
6. SURRENDER
OF CERTIFICATE(S): For any election contained herein to be effective, this
Stock/Cash Election Form and Letter of Transmittal must be accompanied by the
certificate(s) evidencing your shares (or a Notice of Guaranteed Delivery - see
Instruction 15) and any required accompanying evidences of authority (see
Instruction 11).
7. LOST
CERTIFICATE(S): If the certificate(s) that a registered holder (or transferee)
wants to surrender has (have) been lost or destroyed, that holder should
promptly contact the transfer agent for MFB common stock, Registrar &
Transfer Company, at 800-368-5948 to arrange for the replacement of the lost or
destroyed certificate(s) with new certificate(s) (or a Notice of Guaranteed
Delivery, see Instruction 15 below) to be delivered to the Exchange Act with
this Election Form and Letter of Transmittal, properly completed and duly
executed, prior to the Election Deadline.
8. PRIORITY
FOR STOCK ELECTION OR MIXED ELECTION SHARES: If you have made a Stock Election
or Mixed Election and acquired your MFB shares in different lots, you may
designate on this Stock/Cash Election Form and Letter of Transmittal, by stock
certificate number, one or more of such lots for priority allocation of any
stock consideration which you are entitled to receive. The following
is an example of how the priority allocation works. Assume you own
1,000 shares of MFB common stock, 200 of which you acquired in 2004, 300 of
which you acquired in 2006 and 500 of which you acquired in
2008. Assume further that you elect the stock consideration for all
of your MFB
shares
and the number of stock elections by MFB stockholders exceeds the available
stock consideration, such that under the proration provisions of the Merger
Agreement 90% of your MFB shares will be converted to the stock consideration,
with the remaining 10% converting to the cash consideration. By
making a priority designation, you are designating the order (by stock
certificate number) in which your MFB shares are to be allocated the stock
consideration under these circumstances. In the above example, if the
order of your priority designation was: first, the shares acquired in 2008;
second, the shares acquired in 2006; and third, the shares acquired in 2004,
then all of the shares acquired in 2008 and 2006 would convert to the stock
consideration and 100 of the shares acquired in 2004 would convert to the stock
consideration and 100 would convert to the cash consideration. If you
hold a single stock certificate that evidences shares of MFB common stock
acquired in different lots and wish to make a priority designation, you should
consult your personal tax advisor with regard to the method of identifying
particular lots for priority allocation to the stock consideration.
No
assurance can be made that you will receive the tax treatment that you desire as
a result of making a priority designation on this Stock/Cash Election Form and
Letter of Transmittal, and none of
MutualFirst
, MFB, the
Exchange Agent or the Information Agent or any of their respective officers,
directors, employees or agents assumes any responsibility for the tax treatment
that you ultimately receive.
9. TERMINATION
OF MERGER: In the event of termination of the Merger Agreement, the Exchange
Agent will promptly return certificates representing shares of MFB common stock
after being notified of such termination by
MutualFirst
or MFB. In such
event, shares of MFB common stock held through nominees are expected to be
available for sale or transfer promptly following the termination of the Merger
Agreement. Certificates representing shares of MFB common stock held directly by
MFB stockholders will be returned by registered mail (with attendant delay). The
Exchange Agent and
MutualFirst
will use their
commercially reasonable efforts to cooperate with MFB and MFB stockholders to
facilitate the prompt return of MFB stock certificates in the event of
termination of the Merger Agreement, but return of certificates other than by
registered mail will only be made at the expense, written direction and risk of
MFB stockholders, accompanied by a pre-paid, pre-addressed return courier
envelope sent to the Exchange Agent.
10. METHOD
OF DELIVERY: Your MFB stock certificate(s) and this Stock/Cash Election Form and
Letter of Transmittal must be delivered to the Exchange Agent.
Do not send them to
MutualFirst
or MFB
. The method of
delivery of certificates and other documents to be delivered to the Exchange
Agent at the address set forth on the front of this Stock/Cash Election Form and
Letter of Transmittal is at the option and risk of the surrendering
stockholder. Delivery will be deemed effected, and risk of loss
and title to certificates shall pass, only upon proper delivery of such
certificates to the Exchange Agent. If the certificate(s) are sent by
mail, registered mail with return receipt requested and properly insured is
suggested. A return envelope is enclosed. If you are
surrendering your MFB shares via Notice of Guaranteed Delivery, see Instruction
15 below.
11. NEW
CERTIFICATE/CHECK ISSUED IN THE SAME NAME: If the new certificate for
MutualFirst
common stock
and/or the check are to be issued in the same name as the surrendered
certificate is registered, this Stock/Cash Election Form and Letter of
Transmittal should be completed and signed exactly as the surrendered
certificate is registered. Signature guarantees are not required if
the certificate(s) surrendered herewith are submitted by the registered owner of
such shares who has not completed the section entitled "Special Issuance/Payment
Instructions" or are for the account of an Eligible Institution, as defined
below. If any of the shares surrendered hereby are owned by two or more joint
owners, all such owners must sign this Stock/Cash Election Form and Letter of
Transmittal exactly as written on the face of the certificate(s). If any shares
are registered in different names on several certificates, it will be necessary
to complete, sign and submit as many separate Stock/Cash Election Forms and
Letters of Transmittal as there are different
registrations. Stock/Cash Election Forms and Letters of Transmittal
executed by trustees, executors, administrators, guardians, officers of
corporations, or others acting in a fiduciary capacity who are not identified as
such in the registration must be accompanied by proper evidence of the signer's
authority to act.
12. NEW
CERTIFICATE/CHECK ISSUED IN DIFFERENT NAME: If the section entitled "Special
Issuance/Payment Instructions" is completed, then signatures on this Stock/Cash
Election Form and Letter of Transmittal must be guaranteed by a firm that is a
bank, broker, dealer, credit union, savings association or other entity which is
a member in good standing of the Securities Transfer Agents' Medallion Program
(each an "Eligible Institution").
13. SPECIAL
ISSUANCE/PAYMENT AND DELIVERY INSTRUCTIONS: Indicate the name and address in
which the new certificate and/or check is to be sent if different from the name
and/or address of the person(s) signing this Stock/Cash Election Form and Letter
of Transmittal. The stockholder is required to give the social security number
or employer identification number of the record owner of the shares. If Special
Issuance/Payment Instructions have been completed, the stockholder named therein
will be considered the record owner for this purpose.
14. STOCK
TRANSFER TAXES: If any certificate representing shares of
MutualFirst
common stock is
to be issued or any payment of the cash consideration or cash in lieu of
fractional shares is to be made in a name other than that of the registered
holder(s) of the surrendered MFB certificate(s), it shall be a condition of such
issuance and/or payment that the person requesting such exchange either (i) pay
to the Exchange Agent in advance any transfer or other taxes required by reason
of the issuance or payment to a person other than the registered holder(s), or
(ii) establish to the satisfaction of the Exchange Agent that such tax has been
paid or is not applicable.
15. NOTICE
OF GUARANTEED DELIVERY: If your MFB stock certificate(s) cannot be delivered to
the Exchange Agent by the Election Deadline or the procedure for book-entry
transfer to the Exchange Agent’s account at The Depository Trust Company cannot
be completed prior to the Election Deadline, you may still submit an election by
properly completing and duly executing the enclosed Notice of Guaranteed
Delivery and returning it, along with this Stock/Cash Election Form and Letter
of Transmittal, to the Exchange Agent prior to the Election
Deadline.
16. CONSTRUCTION:
All questions with respect to this Stock/Cash Election Form and Letter of
Transmittal raised by holders of MFB common stock (including, without
limitation, questions relating to the time limits or effectiveness of revocation
of any election and questions relating to computations as to allocations) will
be determined by
MutualFirst
and/or the
Exchange Agent, whose determination shall be conclusive and
binding.
MutualFirst
shall have the
right to reject any and all Stock/Cash Election Forms and Letters of Transmittal
not in the proper form or to waive any irregularities in any such form, although
it does not represent that it will do so.
MutualFirst
and/or the
Exchange Agent may, but are not required to, take reasonable action to inform
holders of MFB common stock of any defects and may take reasonable action to
assist such holders to correct any such defects; however, neither
MutualFirst
nor the Exchange
Agent is under any obligation to notify a holder of shares of MFB common stock
of any defect in a Stock/Cash Election Form and Letter of
Transmittal.
17. QUESTIONS: If
you have any questions or would like to receive additional or multiple copies of
this Stock/Cash Election Form and Letter of Transmittal, please call the
Information Agent, Regan & Associates, Inc., at 800-737-3426.
MFB/
MUTUALFIRST
MERGER
STOCK/CASH ELECTION
PROCESS
FREQUENTLY
ASKED QUESTIONS
Set forth below are answers to
frequently asked questions regarding the election process in connection with the
merger of MFB Corp. (“MFB”) and MutualFirst Financial, Inc. (“
MutualFirst”
). We
urge you to read carefully the instructions to the enclosed Stock/Cash Election
Form and Letter of Transmittal and the answers to the Frequently Asked Questions
below. If you have additional questions after reading these
materials, you should call the Information Agent for the election and exchange
process, Regan & Associates, Inc., at 800-737-3426.
After reviewing this information,
please complete and sign the Stock/Cash Election Form and Letter of
Transmittal
and
return it in the enclosed pre-addressed return envelope, along with your MFB
stock certificate(s) or Notice of Guaranteed Delivery (described in Question 8
below), to Continental Stock Transfer & Trust Company (the “Exchange
Agent”), at the address provided on the first page of the Stock/Cash Election
Form and Letter of Transmittal.
Do not send these materials to
MutualFirst
or MFB.
The
deadline for receipt of your Stock/Cash Election Form and Letter of Transmittal
and stock certificate(s) (or Notice of Guaranteed Delivery) is 5:00 p.m.,
Central time, on July 11, 2008, unless extended by
MutualFirst
and
MFB. This date and time are referred to below as the “election
deadline.”
1. Why
have I been sent a Stock/Cash Election Form and Letter of
Transmittal?
|
Pursuant
to the merger agreement, you have the right to elect to receive shares of
MutualFirst
common stock, cash or a combination of both, as consideration for your
shares of MFB common stock, subject to the limitations described in the
answer to Question 9 below. You also have the option to
indicate no preference as to whether you receive shares of
MutualFirst
common
stock, cash or a combination of
both.
|
2.
|
What
is the Stock/Cash Election Form and Letter of
Transmittal?
|
|
The
enclosed Stock/Cash Election Form and Letter of Transmittal does two
things. First, it lets the Exchange Agent know your preferred
form of payment for your shares of MFB common stock (i.e., shares of
MutualFirst
common
stock, cash or a combination of both) or that you have no
preference. Second, it allows you to surrender your MFB stock
certificate(s) in order to receive payment for your MFB shares following
completion of the merger.
|
3.
|
How
do the materials I received in this mailing differ from the proxy
materials I recently received regarding the
merger?
|
|
The
materials you received in this mailing will enable you to elect the form
of consideration (i.e.,
MutualFirst
stock, cash
or a combination of both) you will receive in the merger for your MFB
shares (subject to the proration provisions of the merger agreement
described in Question 9 below). You were previously provided
with a joint proxy statement-prospectus, which was mailed to
MutualFirst
and MFB
stockholders on or about May 1, 2008, for the special meetings of the
stockholders of
MutualFirst
and MFB to
be held on June 11, 2008. That document asks that you vote in
favor of adoption of the merger agreement at the MFB special
meeting.
In
order to vote, you must complete, sign, date and return the proxy card
provided with that document or attend the special meeting and vote in
person
. Your proxy card should be returned using the
postage prepaid envelope provided with the joint proxy
statement-prospectus.
Do not return your proxy card
to the Exchange Agent.
|
4.
|
How
do I use the Stock/Cash Election Form and Letter of
Transmittal?
|
|
Instructions
for completing the Stock/Cash Election Form and Letter of Transmittal are
contained on pages 6 and 7 of that document. You may indicate
your election (or indicate that you have no preference as to the form of
consideration that you will receive) on page 3 of that document, you must
sign on page 4 of that document and you must sign and complete the
Substitute Form W-9 on page 5 of that
document.
|
When
completed, please sign and date the Stock/Cash Election Form and Letter of
Transmittal and mail it to the Exchange Agent in the enclosed pre-addressed
envelope, along with your MFB stock certificate(s) (or a Notice of Guaranteed
Delivery as described in the answer to Question 8 below), so that you can
receive shares of
MutualFirst
common stock,
cash or a combination of both as payment for your shares of MFB common
stock.
Do not
sign the back of your stock certificate(s) and do not send these materials to
MutualFirst
or MFB –
send them to the Exchange Agent
. By signing the Stock/Cash Election Form
and Letter of Transmittal, you are agreeing to surrender your stock
certificate(s) for exchange, you are confirming that your tax identification
number is correctly stated on the Stock/Cash Election Form and Letter of
Transmittal and you are confirming that you have complied with all the
requirements as stated in the instructions.
Please note that if your shares are
held in a joint account, the signature of each joint owner is
required.
5.
|
What
if I am signing the Stock/Cash Election Form and Letter of Transmittal on
behalf of another person or entity as a trustee, executor, administrator,
guardian, corporate officer or in another fiduciary
capacity?
|
If you
are signing the Stock/Cash Election Form and Letter of Transmittal on behalf of
another person or entity as a trustee, executor, administrator, guardian,
corporate officer or in another fiduciary capacity and are not identified as
such in the registration of the surrendered shares (for example, John Smith,
Trustee of XYZ Trust), the Stock/Cash Election Form and Letter of Transmittal
must be accompanied by evidence of your authority to act on behalf of the other
person or entity. If you are signing as a corporate officer, you must
include an originally signed, certified corporate resolution dated within the
last six months bearing the entity’s corporate seal (or indicating there is no
seal). If you are signing as a trustee and the registration of the
surrendered shares does not identify you as trustee as indicated in the above
example, you must enclose a certified copy of the trust agreement stating the
trustee(s) with a medallion guarantee affixed (which can be obtained for a fee
from most banks and brokerage firms). If you are unsure what to do,
call the Information Agent at 800-737-3426.
6.
|
What
if I hold any of my shares of MFB common stock through a bank, broker or
other nominee?
|
If you
hold any shares of MFB common stock through a bank, broker or other nominee,
only they can make an election for your shares in accordance with your
instructions. Please instruct them how make an election with respect
to your shares by completing the election form you receive from
them. Please contact them if you have any questions.
7.
|
What
happens if the Exchange Agent does not receive my properly completed
Stock/Cash Election Form and Letter of Transmittal and my MFB stock
certificate(s) by the election
deadline?
|
|
If
the Exchange Agent does not receive your properly completed Stock/Cash
Election Form and Letter of Transmittal
and
the certificate(s) evidencing your MFB shares (or a Notice of Guaranteed
Delivery described in Question 8 below) prior to the election deadline,
your shares will be deemed “non-election shares.” As a result,
depending on the proper elections of other MFB stockholders, you will
receive either shares of
MutualFirst
common
stock, cash or a combination of both, as determined in accordance with the
allocation provisions of the merger agreement. If you do not
surrender your stock certificate(s) to the Exchange Agent with your
Stock/Cash Election Form and Letter of Transmittal prior to the election
deadline, a separate letter of transmittal will be sent to you after the
merger is completed requesting that you surrender your MFB stock
certificate(s) in order to receive the merger consideration allocated to
you. To the extent you are allocated shares of
MutualFirst
common
stock in exchange for your MFB shares, you will not be entitled to any
dividends or other distributions paid on
MutualFirst
common
stock with a record date after the merger completion date until you
properly surrender your MFB stock certificate(s). Once your
certificate(s) is (are) properly surrendered, you will be paid any such
unpaid dividends or other distributions, without
interest.
|
8.
|
What
is the Notice of Guaranteed Delivery? Do I need to concern
myself with this?
|
|
If
the certificate(s) evidencing your shares of MFB common stock cannot be
delivered to the Exchange Agent by the election deadline, or if the
procedures for book-entry transfer of your shares to the account of the
Exchange Agent at The Depository Trust Company cannot be completed by the
election deadline, you may still make an election by returning your
properly completed and executed Stock/Cash Election Form and Letter of
Transmittal, along with a properly completed and executed Notice of
Guaranteed Delivery, to the Exchange Agent by the election
deadline. The delivery of your shares must then be completed
within three New York Stock Exchange trading days after the election
deadline. The Notice of Guaranteed Delivery must be completed
and executed by a member firm of a registered national securities exchange
(such as the New York Stock Exchange), a member of the Financial Industry
Regulatory Authority (formerly the National Association of Securities
Dealers, Inc.) or a commercial bank or trust company having an office,
branch or agency in the United States. Additional instructions
are contained in the Notice of Guaranteed
Delivery.
|
|
Bottom
line – if you already have the certificate(s) for your MFB shares, you may
disregard the Notice of Guaranteed Delivery. However, the
Exchange Agent must receive your stock certificate(s) and your properly
completed and signed Stock/Cash Election Form and Letter of Transmittal by
the election deadline.
|
9.
|
Am
I guaranteed to receive what I ask for on the Stock/Cash Election Form and
Letter of Transmittal?
|
|
No,
there is no guarantee that you will receive your election
choice. The merger agreement provides that 80% of the
outstanding shares of MFB common stock will be exchanged for shares of
MutualFirst
common stock and 20% of the outstanding shares of MFB common stock will be
exchanged for cash. If MFB stockholders owning more than 80% of
the outstanding shares of MFB common stock elect to receive
MutualFirst
common
stock for their shares, the amount of
MutualFirst
common
stock that each such MFB stockholder will receive from
MutualFirst
will be
reduced on a pro rata basis. As a result of that pro rata
reduction, these MFB stockholders will receive cash for any MFB shares for
which they do not receive
MutualFirst
common
stock. Similarly, if stockholders owning more than 20% of the
outstanding shares of MFB common stock elect to receive cash for their
shares, the amount of cash that each such MFB stockholder will receive
from
MutualFirst
will be reduced on a pro rata basis. As a result of that pro
rata reduction, these MFB stockholders will receive
MutualFirst
common
stock for any MFB shares for which they do not receive
cash.
|
10.
|
If
I indicate on the Stock/Cash Election Form and Letter of Transmittal that
I have no preference, what will I receive in the
merger?
|
|
Your
shares will be considered “non-election shares.” Consequently,
depending on the proper elections of other MFB stockholders, you will
receive shares of
MutualFirst
common
stock, cash or a combination of both depending on the proper elections of
other MFB stockholders.
|
11.
|
How
many shares of
MutualFirst
common
stock will be issued for each MFB share that is to be exchanged for the
stock consideration, and what amount of cash will be paid for each MFB
share that is to be exchanged for the cash
consideration?
|
|
The
stock consideration will consist of 2.59 shares of
MutualFirst
common
stock for each MFB share (referred to as the “exchange ratio”), with cash
paid in lieu of a fractional
MutualFirst
share. The cash consideration will consist of $41.00 for each
MutualFirst
share. For the stock consideration, the amount of cash to be
paid in lieu of each fractional
MutualFirst
share will
be equal to the fraction multiplied by the average of the closing prices
of
MutualFirst
common stock for the five trading days ending on the second trading day
before the date of completion of the
merger.
|
Because
the exchange ratio for the stock consideration is fixed at 2.59
MutualFirst
shares for each
MFB share, the value of the stock consideration will fluctuate with the market
price of
MutualFirst
common stock. Accordingly, at the time of the merger, the per share
value of the stock consideration may be greater or lesser than the per share
value of the cash consideration. On May 29, 2008, the closing price
of
MutualFirst
common
stock was $9.96, making the value of 2.59 shares of
MutualFirst
common stock
equal to $25.80 on that date, as compared to $41.00 for the cash
consideration. You should obtain a current price quotation for
MutualFirst
common
stock.
MutualFirst
common stock trades on the NASDAQ Global Market under the symbol
“MFSF.”
12.
|
When
can I expect to receive my new
MutualFirst
stock
certificates and/or cash?
|
|
Assuming
that you have made a proper election by the election deadline, the
Exchange Agent will use commercially reasonable efforts to mail your check
and/or
MutualFirst
stock
certificate(s) within ten (10) business days after the completion date of
the merger.
|
|
In
the event that the merger agreement is terminated, the Exchange Agent will
promptly return the certificate(s) representing your shares of MFB common
stock previously submitted with your Stock/Cash Election Form and Letter
of Transmittal. In such event, certificates will be returned by
registered mail. Any return other than by registered mail will
only be made at the expense, written direction and risk of holders of MFB
common stock, by means of a pre-paid, pre-addressed return courier
envelope sent to the Exchange
Agent.
|
13.
|
What
if my MFB stock certificate(s) has (have) been lost, stolen or
destroyed?
|
|
If
your MFB stock certificate(s) has (have) been lost, stolen or destroyed,
you should call the transfer agent for MFB common stock, Registrar &
Transfer Company, as soon as possible at (800) 368-5948 to arrange for
replacement of your lost, stolen or destroyed
certificate(s). You will then need to send the replacement
certificate(s)(or a Notice of Guaranteed Delivery, see Question 8) to the
Exchange Agent, along with your properly completed Stock/Cash Election
Form, by the election deadline. As there is a limited amount of
time to accomplish this, please act
quickly.
|
14.
|
Can
I change or revoke my election?
|
Yes. Any
election may be changed or revoked at or prior to the election
deadline. To change or revoke an election, a written notice of
revocation must (1) specify the name of the stockholder having made the election
to be changed or revoked, (2) be signed by the stockholder in the same manner as
the original signature on the Stock/Cash Election Form and Letter of Transmittal
by which the election was made and (3) be received by the Exchange Agent at or
before the election deadline.
If you
revoke your election, the Exchange Agent will return your MFB stock
certificate(s) to you. If you subsequently want to make a new
election, you must return a properly completed Stock/Cash Election Form and
Letter of Transmittal and resubmit your MFB stock certificate(s) (or a Notice of
Guaranteed Delivery) before the election deadline.
15. What
if I received more than one set of election materials? Do I need to
complete them all?
Yes. If
you received more than one set of election materials, this indicates that you
own stock in more than one manner or in more than one name. For
example, you may have some shares registered in your name alone and other shares
registered jointly with someone else. Each set of election materials
you may receive is specific to the manner in which you own your MFB
shares. Failure to complete one of the sets of materials means that
the particular shares to which those materials relate will be deemed
“non-election shares.”
16
.
|
Can
I sell or otherwise transfer my MFB shares after I surrender my stock
certificate(s)?
|
|
No. Although
MFB common stock will continue to trade on the NASDAQ Global Market until
the merger is completed, once you submit your MFB stock certificate(s)
with your Stock/Cash Election Form and Letter of Transmittal, you may not
sell or otherwise transfer these shares unless you revoke your election
before the election deadline.
|
17
.
When do you expect to complete the
merger?
We plan
to complete the merger as soon as practicable after the election
deadline. The completion of the merger is subject to a number of
conditions, however, including approval of the issuance of
MutualFirst
shares in the
merger by the stockholders of
MutualFirst
and adoption of
the merger agreement by the stockholders of MFB, regulatory approvals and other
customary closing conditions. Accordingly, no assurance can be given
as to when or whether the merger will be completed.
18.
|
Will
I have to pay U.S. federal income taxes on the consideration I receive in
the merger?
|
|
If an MFB stockholder receives
solely shares of
MutualFirst
common stock and cash in lieu of
any fractional share, then that stockholder generally will not recognize
any gain or loss, except with respect to the fractional
share.
|
If an MFB
stockholder receives solely cash, then that stockholder generally will recognize
gain or loss equal to the difference between the amount of cash the stockholder
receives and the stockholder’s basis in the stockholder’s MFB shares. The tax
treatment of any gain or loss will depend upon the stockholder’s individual
circumstances.
If an MFB
stockholder receives a combination of
MutualFirst
common stock and
cash other than cash in lieu of a fractional share, then that stockholder will
generally recognize gain in an amount equal to the lesser of the total amount of
cash received or the amount of gain realized on the exchange, but the
stockholder is not permitted to recognize a loss. Any gain recognized may be
treated as a dividend or capital gain, depending on the stockholder’s particular
circumstances.
This tax
treatment may not apply to all MFB stockholders. The U.S. federal income tax
consequences of the merger to MFB stockholders are discussed in greater detail
in the joint proxy statement-prospectus for the merger under “Material U.S.
Federal Income Tax Consequences of the Merger,” beginning on page 63 of that
document. Determining the actual tax consequences of the merger to a
particular MFB stockholder can be complicated. Therefore, you are urged to
consult your personal tax advisor for a full understanding of the merger's tax
consequences that are particular to you.
19.
|
Will
I receive cost basis information for the shares I exchange for
cash?
|
|
Neither
MutualFirst
nor
MFB has a history of the cost basis of your shares of MFB common
stock. If you have not kept a record of your MFB stock
purchases and the shares were purchased through a broker, the broker may
be able to provide you with this
information.
|
20.
|
What
if I acquired MFB shares in multiple lots and wish to designate one or
more lots for priority allocation to
MutualFirst
stock in
the event
MutualFirst
stock is
oversubscribed?
|
If you
have made a stock election or a mixed (stock and cash) election and acquired
your MFB shares in different lots, you may designate on the Stock/Cash Election
Form and Letter of Transmittal, by stock certificate number, one or more of such
lots for priority allocation of any stock consideration which you are entitled
to receive. Assume, for example, that you own 1,000 shares of MFB
common stock, 200 of which you acquired in 2004, 300 of which you acquired in
2006 and 500 of which you acquired in 2008. Assume further that you
elect to receive
MutualFirst
stock for all of
your MFB shares and the number of stock elections by MFB stockholders exceeds
the available pool of
MutualFirst
stock, such that
under the proration provisions 90% of your MFB shares will be converted to
MutualFirst
stock, with the
remaining 10% converting to cash. By making a priority designation,
you are designating the order (by stock certificate number) in which your MFB
shares are to be allocated
MutualFirst
stock. In the above example, if the order of your priority
designation was: first, the shares acquired in 2008; second, the shares acquired
in 2006; and third, the shares acquired in 2004, then all of the shares acquired
in 2008 and 2006 would convert to
MutualFirst
stock and 100 of
the shares acquired in 2004 would convert to
MutualFirst
stock and 100
would convert to cash.
If you
hold a single stock certificate that evidences shares of MFB common stock
acquired in different lots and wish to make a priority designation, there is no
specific mechanism on the Stock/Cash Election Form and Letter of Transmittal for
doing so. In this case, you should consult your personal tax advisor
with regard to the method of identifying particular lots for priority allocation
to
MutualFirst
stock.
No
assurance can be made that you will receive the tax treatment that you desire as
a result of making a priority designation on the Stock/Cash Election Form and
Letter of Transmittal, and none of
MutualFirst
, MFB, the
Exchange Agent or the Information Agent or any of their respective officers,
directors, employees or agents assumes any responsibility for the tax treatment
that you ultimately receive.
21.
|
How
should I send in my signed documents and stock
certificate(s)?
|
|
A
return envelope pre-addressed to the Exchange Agent is enclosed with this
package. Please use this envelope to return your Stock/Cash
Election Form and Letter of Transmittal, your MFB stock certificate(s)(or
Notice of Guaranteed Delivery), and any additional documentation that may
be required to make your election complete. It is recommended
that you return these materials by registered mail, return receipt
requested, and insured for 2.0% of the market value of your shares, if the
package contains the certificate(s) for your MFB shares. This is the
typical amount of the indemnity bond you would be required to post to
replace a lost certificate.
If you do not have
the envelope, please mail all the requested documentation to: Continental
Stock Transfer & Trust Company, Reorganization Department, 17 Battery
Place, 8
th
Floor, New York, New York 10004.
Note, however, that these
materials must be
actually
received
by the
Exchange Agent by the election deadline.
Therefore, if
you are delivering materials shortly before the election deadline, you may
wish to instead deliver these materials by in-hand delivery or overnight
courier to the same address.
Please do not return any of
these materials to MFB or
MutualFirst
.
|
22.
|
Are
there any fees associated with the exchange of my MFB stock
certificate(s)?
|
|
There
are no fees associated with the exchange, unless you need to replace a
lost, stolen or destroyed MFB stock certificate or if you need to have
your signature medallion guaranteed, in which case the guarantor may
charge you for this service.
|
23.
|
How
do I change my address on the Stock/Cash Election Form and Letter of
Transmittal?
|
|
Mark
through any incorrect address information that is printed on the front of
the Stock/Cash Election Form and Letter of Transmittal. Clearly print the
correct address in the area beside the printed information. If
you would like to receive your payment under the merger at a different
address from that imprinted on the front of the Stock/Cash Election Form
and Letter of Transmittal, please complete the box entitled “Special
Delivery Instructions” on the Stock/Cash Election Form and Letter of
Transmittal.
|
|
a)
|
I
want shares of
MutualFirst
common stock to be issued to someone other than the person named on the
surrendered certificate(s)?
|
|
|
|
|
b)
|
I
want to have a check made payable to someone other than the person named
on the surrendered certificate(s)?
|
|
c)
|
The
owner or co-owner of the shares evidenced by the surrendered
certificate(s) is deceased?
|
|
Please
complete the “Special Issuance/Payment Instructions” box on the Stock/Cash
Election Form and Letter of Transmittal in order to have the
MutualFirst
shares or
check issued to someone else. As noted in Instruction 12 on the
Stock/Cash Election Form and Transmittal Letter, your signature must be
medallion guaranteed.
|
25.
|
Whom
should I call if I have additional
questions?
|
|
You should call the Information
Agent, Regan & Associates, Inc., at
800-737-3426
.
|
MFB
Corp. Merger with
MutualFirst
Financial,
Inc.
IMPORTANT ELECTION
INFORMATION
To Our
Clients:
MFB Corp.
(“MFB”) has agreed to merge with and into a wholly owned subsidiary of
MutualFirst
Financial, Inc.
(“
MutualFirst
”),
pursuant to to the Agreement and Plan of Merger, dated as of January 7, 2008, by
and among
MutualFirst,
MutualFirst Acquisition Corp. and MFB. The merger is subject to adoption
of the merger agreement by the stockholders of MFB, the approval of the issuance
of shares of
MutualFirst
common stock in
the merger by the stockholders of
MutualFirst
, and the receipt
of all required regulatory approvals. In the merger, subject to the
proration provisions of the merger agreement described below, you have the right
to elect to receive, for each share of MFB common stock that you own, either
2.59 shares of
MutualFirst
common stock,
with cash paid in lieu of fractional share interests (the “stock
consideration”), or $41.00 in cash (the “cash consideration”). You
may specify different elections with respect to different shares that you hold
(if, for example, you hold 100 shares of MFB common stock, you can make a stock
election with respect to 50 shares and a cash election with respect to 50
shares). For the stock consideration, the amount of cash to be paid
in lieu of each fractional share interest will be equal to the fraction
multiplied by the average of the closing prices of
MutualFirst
common stock for
the five trading days ending on the second trading day before the date of
completion of the merger.
Because
the exchange ratio for the stock consideration is fixed at 2.59
MutualFirst
shares for each
MFB share, the value of the stock consideration will fluctuate with the market
price of
MutualFirst
common stock. Accordingly, at the time of the merger, the per share
value of the stock consideration may be greater or lesser than the per share
value of the cash consideration. On May 29, 2008, the closing price
of
MutualFirst
common
stock was $9.96, making the value of 2.59 shares of
MutualFirst
common stock
equal to $25.80 on that date, as compared to $41.00 for the cash
consideration. You should obtain a current price quotation for
MutualFirst
common
stock.
MutualFirst
common stock trades on the NASDAQ Global Market under the symbol
“MFSF.” Please note that the stock and/or cash consideration you are
entitled to receive in the merger will be paid to us first and then distributed
to you pursuant to our procedures.
The
merger agreement provides that 80% of the shares of MFB common stock outstanding
immediately prior to the effective time of the merger will be exchanged for the
stock consideration, with the remaining 20% of the outstanding MFB shares
exchanged for the cash consideration. As a result, if the holders of
more than 80% of the outstanding MFB shares make valid elections to receive the
stock consideration or if the holders of more than 20% of the outstanding MFB
shares make valid elections to receive the cash consideration, those MFB
stockholders electing the over-subscribed form of consideration will have the
over-subscribed form of consideration proportionately reduced and will receive a
portion of their consideration in the other form, despite their
election.
Therefore,
you might receive
MutualFirst
stock and/or cash in an amount that
is not consistent with your election, depending upon the elections of other MFB
stockholders.
For a description of the proration provisions of
the Merger Agreement, see “The Merger Agreement—Merger Consideration—Proration”
beginning on page 72 of the joint proxy statement-prospectus for the merger,
which was separately mailed to
MutualFirst
and MFB
stockholders on or about May 1, 2008. The joint proxy
statement-prospectus is contained within the amended Registration Statement on
Form S-4 filed by
MutualFirst
with the
Securities and Exchange Commission on April 25, 2008, which can be retrieved by
accessing
MutualFirst’s
filings at the Securities and Exchange Commission’s website, at
www.sec.gov
.
BECAUSE WE ARE THE HOLDER OF RECORD FOR
YOUR MFB SHARES, ONLY
WE
CAN MAKE AN
ELECTION FOR YOUR SHARES IN ACCORDANCE WITH YOUR INSTRUCTIONS. PLEASE
INSTRUCT US ON HOW TO MAKE THE ELECTION FOR YOUR SHARES--FOR STOCK, CASH OR A
COMBINATION OF BOTH ON THE INSTRUCTION FORM ON PAGE 3. IF YOU DO NOT PROVIDE US
WITH ELECTION INSTRUCTIONS, WE WILL NOT MAKE AN ELECTION FOR YOU AND THE FORM OF
CONSIDERATION YOU WILL RECEIVE WILL BE DETERMINED PURSUANT TO THE MERGER
AGREEMENT WITHOUT REGARD TO YOUR PREFERENCES.
If you have any questions, please
contact your broker or financial advisor directly, or, alternatively, call the
Information Agent for the election process, Regan & Associates, Inc., at
800-737-3426.
PLEASE
NOTE THE FOLLOWING:
*
|
The election period will expire
at 5:00 p.m. Central time on July 11, 2008. IT IS THEREFORE
IMPERATIVE THAT WE RECEIVE YOUR INSTRUCTIONS AS SOON AS POSSIBLE PRIOR TO
THIS DEADLINE IN ORDER TO PROPERLY FULFILL YOUR
INSTRUCTIONS
.
|
*
|
With
respect to the shares of MFB common stock held by us in your account, you
can instruct us how to make an election on your behalf – for stock, cash
or a combination of both - by using the instruction form provided on page
3. Only we can make an election on your
behalf.
|
*
|
If
we do not receive your election instructions in time to comply with the
election deadline of July 11, 2008, this will have the same effect as not
responding. Under these circumstances, the terms of the merger
agreement will determine whether stock, cash or a combination of stock and
cash will be distributed to you, without regard to your
preference.
|
*
|
There
is no guarantee that you will receive your election choice. If
you elect all cash and the available cash is oversubscribed, then you will
receive a portion of the merger consideration in
MutualFirst
stock. If you elect all stock and the available stock is
oversubscribed, then you will receive a portion of the merger
consideration in cash.
|
*
|
The
receipt of cash generally will be a taxable event for United States
federal income tax purposes. Because individual circumstances
may differ, stockholders should consult their tax advisors prior to making
an election to determine the tax effect to them of the merger, including
the application and effect of foreign, state, local or other tax
laws.
|
Please
provide your signed instructions below:
CHECK
ONE BOX ONLY TO INDICATE YOUR CASH/STOCK ELECTION INSTRUCTION
|
(1)
|
Stock Election
-- All
shares of MFB stock I own converted into the stock
consideration;
|
or
|
(2)
|
Cash Election
-- All
shares of MFB stock I own converted into the cash
consideration;
|
or
|
(3)
|
Mixed Election
-- a
combination of stock and cash as
follows:
|
|
|
_________
shares of MFB stock converted into the stock consideration,
and
|
|
|
_________
shares of MFB stock converted into the cash
consideration.
|
|
|
_________ Total
(cannot exceed the total number of MFB shares you
own).
|
If you do
not wish to make an election, do not return this form.
Account
Number:______________
____________________________________
|
|
______________________________________
|
______________________________
|
Signature
of Accountholder
|
|
Signature
of Accountholder
|
Date
|
|
|
(if
joint account)
|
|
______________________
Daytime
phone no.
MFB
Corp.
Important Election
Information
June 6,
2008
To
Brokers, Dealers, Commercial Banks, Trust Companies and other
Nominees:
The
right to make an election will expire at 5:00 p.m. Central time, on July
11, 2008. The time and date of the expiration of the election
period is herein referred to as the “Election
Deadline.”
|
MFB Corp.
(“MFB”) has agreed to merge with and into a wholly owned subsidiary of
MutualFirst
Financial, Inc.
(“
MutualFirst
”),
pursuant to the Agreement and Plan of Merger, dated as of January 7, 2008, by
and among
MutualFirst,
MutualFirst Acquisition Corp. and MFB. The merger is subject to adoption
of the merger agreement by the stockholders of MFB, the approval of the issuance
of shares of
MutualFirst
common stock in
the merger by the stockholders of
MutualFirst
, and the receipt
of all required regulatory approvals. In the merger, subject to the
proration provisions of the merger agreement described below, MFB stockholders
have the right to elect to receive, for each share of MFB common stock that they
own, either 2.59 shares of
MutualFirst
common stock,
with cash paid in lieu of fractional share interests (the “stock
consideration”), or $41.00 in cash (the “cash consideration”). An MFB
stockholder may specify different elections with respect to different shares
that he or she holds (if, for example, he or she holds 100 shares of MFB common
stock, he or she can make a stock election with respect to 50 shares and a cash
election with respect to 50 shares). For the stock consideration, the
amount of cash to be paid in lieu of each fractional share interest will be
equal to the fraction multiplied by the average of the closing prices of
MutualFirst
common stock for
the five trading days ending on the second trading day before the date of
completion of the merger.
Because
the exchange ratio for the stock consideration is fixed at 2.59
MutualFirst
shares for each
MFB share, the value of the stock consideration will fluctuate with the market
price of
MutualFirst
common stock. Accordingly, at the time of the merger, the per share
value of the stock consideration may be greater or lesser than the per share
value of the cash consideration. On May 29, 2008, the closing price
of
MutualFirst
common
stock was $9.96, making the value of 2.59 shares of
MutualFirst
common stock
equal to $25.80 on that date, as compared to $41.00 for the cash
consideration.
The
merger agreement provides that 80% of the shares of MFB common stock outstanding
immediately prior to the effective time of the merger will be exchanged for the
stock consideration, with the remaining 20% of the outstanding MFB shares
exchanged for the cash consideration. As a result, if the holders of
more than 80% of the outstanding MFB shares make valid elections to receive the
stock consideration or if the holders of more than 20% of the outstanding MFB
shares make valid elections to receive the cash consideration, those MFB
stockholders electing the over-subscribed form of consideration will have the
over-subscribed form of consideration proportionately reduced and will receive a
portion of their consideration in the other form, despite their
election.
Therefore,
an MFB stockholder might receive
MutualFirst
stock and/or cash in an amount that
is not consistent with his or her election, depending upon the elections of
other MFB stockholders.
For a description of the proration
provisions of the Merger Agreement, see “The Merger Agreement—Merger
Consideration—Proration” beginning on page 72 of the joint proxy
statement-prospectus for the merger, which was separately mailed to
MutualFirst
and MFB
stockholders on or about May 1, 2008. The joint proxy
statement-prospectus is contained within the amended Registration Statement on
Form S-4 filed by
MutualFirst
with the
Securities and Exchange Commission on April 25, 2008, which can be retrieved by
accessing
MutualFirst’s
filings at the Securities and Exchange Commission’s website, at
www.sec.gov
.
AS
NOTED ABOVE, BECAUSE THERE WILL BE LIMITS ON THE NUMBER OF MFB SHARES THAT MAY
BE EXCHANGED FOR EACH OF THE STOCK AND CASH CONSIDERATION, ELECTIONS WILL BE
SUBJECT TO PRORATION. THEREFORE, THE ALLOCATION OF
MUTUALFIRST
COMMON STOCK AND
CASH THAT AN MFB STOCKHOLDER WILL RECEIVE WILL DEPEND ON THE PROPER AND TIMELY
ELECTIONS OF OTHER MFB STOCKHOLDERS. IF NO OPTION IS CHOSEN, THE STOCKHOLDER
WILL BE DEEMED TO HAVE NO PREFERENCE AND THE TYPE OF CONSIDERATION TO BE GIVEN
WILL BE DETERMINED UNDER THE MERGER AGREEMENT.
For your
information and for forwarding to those of your clients for whom you hold shares
of MFB common stock registered in your name or in the name of your nominee, we
are enclosing the following documents: (1) a Stock/Cash Election Form and Letter
of Transmittal; (2) a Notice of Guaranteed Delivery to be used to make an
election if none of the procedures for delivering the necessary certificates
representing MFB shares can be completed on a timely basis; (3) answers to
frequently asked questions about the merger and the election process; (4) a
proposed client letter which you may wish to use to obtain election instructions
from your clients; and (5) Substitute Form W-9 guidelines.
YOUR PROMPT ACTION IS REQUIRED.
PLEASE CONTACT YOUR CLIENTS AS SOON AS POSSIBLE. PLEASE NOTE THAT THE RIGHT TO
MAKE AN ELECTION WILL EXPIRE AT 5:00 P.M., CENTRAL TIME, ON JULY 11,
2008.
For an
election to be valid, a duly executed and properly completed Stock/Cash Election
Form and Letter of Transmittal, including any required signature guarantees and
any other required documents, must be received by the Exchange Agent, together
with either certificate(s) representing surrendered MFB shares or timely
confirmation of their book-entry transfer to the account of the Exchange Agent
at The Depository Trust Company, by the Election Deadline. The
Exchange Agent is Continental Stock Transfer & Trust Company (tel.: (212)
509-4000 ext. 536). Stockholders who cannot deliver their stock certificate(s)
to the Exchange Agent, or cannot complete the procedures for book-entry
transfer, prior to the Election Deadline must surrender their shares according
to the procedure for guaranteed delivery set forth in the enclosed Notice of
Guaranteed Delivery. No fees or commissions will be payable by
MutualFirst
, MFB or any
officer, director, stockholder, agent, or other representative of either of them
to any broker, dealer or other person for soliciting surrender of shares
pursuant to the election (other than fees paid to the Exchange Agent and the
Information Agent for their services in connection with the election and
exchange process).
MutualFirst
will, however,
upon request, reimburse you for customary mailing and handling expenses incurred
by you in forwarding any of the enclosed materials to your clients whose shares
are held by you as a nominee or in a fiduciary capacity.
Any
inquiries you may have with respect to the election should be directed to the
Information Agent for the election and surrender of MFB shares, Regan &
Associates, Inc., at (800) 737-3426. Additional copies of the
enclosed materials may be obtained by contacting the Information Agent at the
same telephone number.
Very
truly yours,
|
|
|
|
|
/s/David
W. Heeter
|
|
|
/s/
Charles J. Viater
|
|
David
W. Heeter
|
|
|
Charles
J. Viater
|
|
President
and Chief Executive Officer
MutualFirst
Financial,
Inc.
|
|
|
President
and Chief Executive Officer
MFB Corp.
|
|
NOTHING
CONTAINED HEREIN OR IN THE ENCLOSED DOCUMENTS SHALL CONSTITUTE YOU OR ANY PERSON
AS AN AGENT OF
MUTUALFIRST
, MFB, THE
EXCHANGE AGENT, THE INFORMATION AGENT OR ANY AFFILIATE OF ANY OF THE
FOREGOING.
NOTICE OF
GUARANTEED DELIVERY
OF
SHARES OF
COMMON STOCK
OF
MFB
CORP.
This form, or a facsimile hereof, must
be used in connection with your election with respect to your shares of common
stock of MFB Corp. ("MFB") in connection with the proposed merger of MFB with
and into a wholly owned subsidiary of
MutualFirst
Financial, Inc.
(“
MutualFirst
”) if (1)
the certificates for your shares of MFB common stock cannot be delivered to the
Exchange Agent by 5:00 p.m., Central time, on July 11, 2008 (the "Election
Deadline"), or (2) the procedure for book-entry transfer of your shares of MFB
common stock to the account of the Exchange Agent at The Depository Trust
Company cannot be completed prior to the Election Deadline.
This form, properly completed and duly
executed, may be delivered by hand, mail or facsimile transmission to the
Exchange Agent, and must be received by the Exchange Agent along with your
properly completed and executed Stock/Cash Election Form and Letter of
Transmittal by the Election Deadline.
THE
EXCHANGE AGENT IS:
CONTINENTAL
STOCK TRANSFER & TRUST COMPANY
By
Hand, Mail or Overnight Courier:
|
By
Facsimile:
|
Continental
Stock Transfer & Trust Company
|
(212)
616-7610
|
Reorganization
Department
17
Battery Place, 8
th
Floor
New York,
New York 10004
Tel.:
(212) 509-4000 ext. 536
Delivery of this form to an address
other than as set forth above or transmission of this form to a facsimile number
other than as set forth above does not constitute a valid delivery.
The Information Agent for stockholder
inquiries is
REGAN &
ASSOCIATES, INC.
The Information Agent can be reached toll
free, at (800) 737-3426.
This form is not to be used to
guarantee signatures. If a signature on a Stock/Cash Election Form
and Letter of Transmittal requires a Medallion Signature Guarantee, such
Medallion Signature Guarantee must appear in the applicable space provided on
the Stock/Cash Election Form and Letter of Transmittal.
Ladies
and Gentlemen:
The undersigned hereby surrenders to
Continental Stock Transfer & Trust Company, as the Exchange Agent, upon the
terms and subject to the conditions set forth in the Stock/Cash Election Form
and Letter of Transmittal, the number of shares of MFB common stock set forth
below pursuant to the guaranteed delivery procedures set forth
below.
Number of
Shares Surrendered:
Certificate
Nos. (If available):
Name(s)of
Record Holder(s):
Address:
Area Code
and Telephone Number ( )
_______________________
Social
Security Number_______-_____-_______ or
Employer
Identification Number ____________
Dated: _____________,
2008
Signature(s)
[ ]
Check here if shares will be tendered by book-entry transfer and fill in the
information below:
DTC
Account Number: ___________
Transaction
Code Number: ________
GUARANTEED DELIVERY
PROCEDURE
In order for an election to be
effective, Continental Stock Transfer & Trust Company, as the Exchange
Agent, must receive a properly completed and duly executed Stock/Cash Election
Form and Letter of Transmittal, accompanied by the certificate(s) representing
shares of MFB common stock currently held by you, a confirmation evidencing the
transfer of all MFB shares tendered by book-entry transfer to the account of the
Exchange Agent at The Depository Trust Company, or a proper guarantee of
delivery (as described below), no later than the Election Deadline (as specified
above). Persons whose certificates are not immediately available or
the tendering of whose MFB shares cannot be completed by book-entry transfer by
the Election Deadline also may make an election by completing and executing the
Stock/Cash Election Form and Letter of Transmittal (or a facsimile thereof) and
submitting it to the Exchange Agent by the Election Deadline and by having a
Guarantee of Delivery properly completed and duly executed by the Election
Deadline by a member of a registered national securities exchange
or the Financial Industry Regulatory Authority, Inc. (formerly the
National Association of Securities Dealers, Inc.) or by a commercial bank or
trust company having an office, branch or agency in the United States (subject
to the condition that the certificates (or a confirmation evidencing the
transfer of all MFB shares tendered by book-entry transfer), the delivery of
which is thereby guaranteed, are in fact delivered to the Exchange Agent within
three New York Stock Exchange trading days after the Election
Deadline.
GUARANTEE
The
undersigned, a member firm of a registered national securities exchange, a
member of the Financial Industry Regulatory Authority, Inc. (formerly the
National Association of Securities Dealers, Inc.), or a commercial bank or trust
company having an office, branch, or agency in the United States, hereby
guarantees to deliver to the Exchange Agent certificates representing the shares
tendered hereby, in proper form for transfer (or surrender shares pursuant to
the procedure for book-entry transfer into the Exchange Agent’s account at The
Depository Trust Company), together with any other required documents, within
three New York Stock Exchange trading days after the Election
Deadline.
Name
of
Firm:
|
__________________________________
(authorized
signature)
|
Address:
|
Name:
|
_____________________________________________________________
|
Title:
|
City
|
State
|
Zip
Code
|
Dated:
_________________________ 2008
|
Area
Code and Tel. No.:
|
|
|
|
GUIDELINES
FOR CERTIFICATION OF TAXPAYER IDENTIFICATION
NUMBER
ON SUBSTITUTE FORM W-9
Guidelines for Determining the Proper
Identification Number to Give the Payer
. Social Security
numbers have nine digits separated by two hyphens: i.e.
000-00-0000. Employer identification numbers have nine digits
separated by only one hyphen: i.e. 00-0000000. The table
below will help determine the proper identification number to give the
payer.
For
this type of account:
|
Give
the NAME and
SOCIAL
SECURITY number of:
|
|
For
this type of account:
|
Give
the EMPLOYER IDENTIFICATION number of:
|
1.Individual
|
The
individual
|
|
7.A
valid trust, estate, or pension trust
|
The
legal entity (4)
|
2.Two
or more individuals (joint account)
|
The
actual owner of the account or, if combined funds, the first individual on
the account(1)
|
|
8.Corporate
or LLC electing corporate status on Form 8832 account
|
The
corporation
|
3.Custodian
account of a minor (Uniform Gift to Minors Act)
|
The
minor(2)
|
|
9.Association,
club, religious, charitable, educational or other tax-exempt
organization
|
The
organization
|
4. a. The
usual revocable savings trust (grantor is also trustee)
b. So-called
trust account that is not a legal or valid trust under state
law
5.Sole
proprietorship or disregarded entity owned by an individual
6.Disregarded
entity not owned by an individual
|
a. The
grantor-trustee(1)
b. The
actual owner(1)
The
owner(3)
The
owner
|
|
10.Partnership
or multi-member LLC
11.A
broker or registered nominee
12.Account
with the Department of Agriculture in the name of a public entity (such as
a state or local government, school district, or prison) that receives
agricultural program payments
|
The
partnership
The
broker or nominee
The
public entity
|
(1)
|
List
first and circle the name of the person whose number you
furnish. If only one person on a joint account has a Social
Security number, that person’s number must be
furnished.
|
(2)
|
Circle
the minor's name and furnish the minor's Social Security
number.
|
(3)
|
You
must show your individual name and you may also enter your business or
“DBA” name on the second name line. You may use either your
Social Security number or Employer Identification number (if you have
one), but the IRS encourages you to use your Social Security
number.
|
(4)
|
List
first and circle the name of the legal trust, estate, or pension
trust. (Do not furnish the taxpayer identification number of
the personal representative or trustee unless the legal entity itself is
not designated in the account
title.)
|
NOTE:
|
If no name is circled when
there is more than one name, the number will be considered to be that of
the first name listed.
|
GUIDELINES
FOR CERTIFICATION OF TAXPAYER IDENTIFICATION
NUMBER
ON SUBSTITUTE FORM W-9
Page
2
Obtaining
a Number
If
you do not have a taxpayer identification number (“TIN”) apply for one
immediately. To apply for a Social Security number, get Form
SS-5, Application for a Social Security Card, from your local Social
Security Administration office or get this form online at
www.ssa.gov
. You
may also get this form by calling 1-800-772-1213. Use Form W-7,
Application for IRS Individual Taxpayer Identification Number, to apply
for an Individual Tax Identification Number, or Form SS-4, Application for
Employer Identification Number, to apply for an Employer Identification
Number. You can apply for an Employer Identification Number
online by accessing the IRS website at
www.irs.gov/business
and clicking on Employer Identification Number (EIN) under Starting a
Business. You can get Forms W-7 and SS-4 from the IRS by
visiting
www.irs.gov
or
by calling 1-800-TAX-FORM (1-800-829-3676). If you do not have
a TIN, write “Applied For” in the space for the TIN.
Payees
Exempt from Backup Withholding
Payees
specifically exempted from backup withholding on all dividend and interest
payments and on broker transactions include the following (section
references are to the applicable sections of the Internal Revenue Code of
1986, as amended):
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Certain
other payees may be exempt from either dividend and interest payments or
broker transactions. You should consult your tax advisor to
determine whether you might be exempt from backup
withholding. Exempt payees described above should file the
substitute W-9 to avoid possible erroneous backup
withholding. Complete the substitute Form W-9 as
follows:
ENTER
YOUR TAXPPAYER IDENTIFICATION NUMBER, WRITE “EXEMPT” ACROSS THE FACE OF
THE FORM, SIGN AND DATE THE FORM AND RETURN THE FORM TO THE
PAYER.
IF
YOU ARE A NONRESIDENT ALIEN OR FOREIGN ENTITY NOT SUBJECT TO BACKUP
WITHHOLDING, GIVE THE PAYER THE APPROPRIATE COMPLETED FORM
W-8.
Privacy Act
Notice
. Section 6109 requires you to provide your
correct taxpayer identification number to payers who must report the
payments to the IRS. The IRS uses the number for identification
purposes and to help verify the accuracy of your tax return and may also
provide this information to various government agencies for tax
enforcement or litigation purposes. You must provide your
taxpayer identification
number whether or not you are required
to file a tax return. Payers must generally withhold 28% of
taxable interest, dividend and certain other payments to a payee who does
not give a taxpayer identification number to a payer. Certain penalties
may also apply.
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An
organization exempt from tax under Section 501(a), any individual
retirement account, or a custodial account under Section 403(b)(7) if the
account satisfies the requirements of Section
401(f)(2).
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The
United States or any of its agencies or
instrumentalities.
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(1)
Penalty for Failure to Furnish
Taxpayer Identification Number
. If you fail to furnish
your taxpayer identification number to a payer, you are subject to a
penalty of $50 for each such failure unless your failure is due to
reasonable cause and not to willful neglect.
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A
state, the District of Columbia, a possession of the United States, or any
of their subdivisions or instrumentalities.
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(2)
Civil Penalty for False
Information With Respect To Withholding.
If you
make a false statement with no reasonable basis which results in no
imposition of backup withholding, you are subject to a penalty of
$500.
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A
foreign government or any of its political subdivisions, agencies or
instrumentalities.
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An
international organization or any of its agencies or
instrumentalities.
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(3)
Criminal Penalty for Falsifying
Information
. Willfully falsifying certifications
or affirmations may subject you to criminal penalties including fines
and/or imprisonment.
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Other payees that may be
exempt from backup withholding include the
following:
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FOR ADDITIONAL INFORMATION
CONTACT YOUR TAX CONSULTANT OR THE IRS.
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A
corporation.
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A
foreign central bank of issue.
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A
dealer in securities or commodities required to register in the United
States, the District of Columbia or a possession of the United
States.
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A
futures commission merchant registered with the Commodity Futures Trading
Commission.
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A
real estate investment trust.
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An
entity registered at all times during the tax year under the Investment
Company Act of 1940.
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A
common trust fund operated by a bank under Section 584(a).
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A
financial institution.
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A
middleman known in the investment community as a nominee or
custodian.
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A
trust exempt from tax under Section 664 (charitable remainder trust) or
described in Section 4947.
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