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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Nickle Andrew W. 560 SEA OAK DRIVE VERO BEACH, FL 32963 |
10% Group Member |
/s/ Andrew W. Nickle | 10/19/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Indirect through E.L. Morris fbo E.C. Nickle Trust. |
(2) | Indirect through E.C. Nickle Charitable Annuity Trust. |
(3) | Indirect through E.L. Morris Trust FBO Ernestine C. Nickle Family. |
(4) | Indirect through Ernestine M. Raclin Charitable Irrev Trust FBO Ernestine C. Nickle Family. |
(5) | Indirect through Ernestine M. Raclin Irrevocable Trust FBO Ernestine C. Nickle Family. |
(6) | Indirect through Ella Morris Charitable Trust FBO Ernestine C. Nickle Family. |
(7) | Indirect through E.L. Morris Charitable Living Trust FBO Ernestine C. Nickle Family. |
(8) | Indirect through Ernestine M. Raclin Irrevocable Trust FBO Ernestine C. Nickle Family. |
(9) | The reporting person's spouse has the power to direct the trustee with respect to the disposition of the reported securities. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of all of the reported securities for purposes of Section 16 or for any other purpose. |
(10) | Indirect through Mr. Nickle's spouse. |
(11) | The price reported in column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $31.04 to $31.05, inclusive. The reporting person undertakes to provide to 1st Source Corporation, any security holder of 1st Source Corporation, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the range set forth in this footnote. |