Statement of Changes in Beneficial Ownership (4)
04 Septembre 2019 - 7:38PM
Edgar (US Regulatory)
FORM 4
[X]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
SKIBSKI JOHN L |
2. Issuer Name and Ticker or Trading Symbol
MBT FINANCIAL CORP
[
MBTF
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Executive VP & CFO
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(Last)
(First)
(Middle)
102 E. FRONT ST. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/1/2019
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(Street)
MONROE, MI 48161
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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9/1/2019
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D
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78614
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D
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(1)
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0
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D
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Common Stock
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9/1/2019
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D
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4000
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D
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(1)
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0
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I
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Spouse's IRA
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code (Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)
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8. Price of Derivative Security (Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Only Stock Appreciation Rights
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$4.90
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9/1/2019
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D
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5000
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(2)
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3/7/2024
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Common Stock
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5000
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$0
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0
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D
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Stock Only Stock Appreciation Rights
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$5.79
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9/1/2019
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D
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7300
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(3)
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5/28/2025
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Common Stock
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7300
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$0
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0
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D
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Stock Only Stock Appreciation Rights
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$8.26
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9/1/2019
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D
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5000
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(4)
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2/25/2026
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Common Stock
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5000
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$0
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0
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D
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Explanation of Responses:
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(1)
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Disposed of pursuant to the merger agreement between the issuer and First Merchants Corporation ("First Merchants"), each share of which was converted into 0.2750 shares of First Merchants common stock having a market value of $35.72 per share on the effective date of the merger.
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(2)
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This SOSAR, which originally vested in 3 equal annual installments beginning on December 31, 2014, was cancelled in the merger in exchange for a cash payment of $23,363.75, based upon the closing price of the acquirer's common stock on August 27, 2019.
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(3)
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This SOSAR, which originally vested in 3 equal annual installments beginning on December 31, 2015, was cancelled in the merger in exchange for a cash payment of $27,614.08, based upon the closing price of the acquirer's common stock on August 27, 2019.
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(4)
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This SOSAR, which originally vested in 3 equal annual installments beginning on December 31, 2016, was cancelled in the merger in exchange for a cash payment of $6,563.75, based upon the closing price of the acquirer's common stock on August 27, 2019.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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SKIBSKI JOHN L 102 E. FRONT ST. MONROE, MI 48161
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X
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Executive VP & CFO
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Signatures
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/s/ John L. Skibski
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9/4/2019
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**Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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