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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 | ||||||||
Stock Option (right to buy) | $ 15.85 | 12/03/2012 | M(5) | 400 | (8) | 02/21/2013 | Common Stock | 400 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Sheeley Michael J. 118 SECOND AVENUE SE CEDAR RAPIDS, IA 52407-3909 |
VP/COO - United Life Ins. Co. |
/s/ Michael J. Sheeley by Dianne M. Lyons, Attorney-in-Fact | 12/05/2012 | |
**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) | The deemed execution date of this transaction is based on a report of the Issuer's Employee Stock Purchase Plan administor and transfer agent. |
(2) | Shares acquired through payroll deduction and participation in Issuer's Employee Stock Purchase Plan. |
(3) | Represents the approximate number of shares acquired by the administrator of the Issuer's Employee Stock Purchase Plan for the Reporting Person, based on a statement of the administrator. |
(4) | The price per share is based on a statement provided by the Issuer's Employee Stock Purchase Plan administrator. |
(5) | This transaction represents the exercise of vested, in-the-money stock options. |
(6) | The price per share is the closing price of the Issuer's common stock on the date of the reported transaction. |
(7) | This tranaction represents the exempt transfer of securities held longer than six months by Reporting Person to the Issuer to pay the exercise price of vested, in-the-money stock options. |
(8) | All options currently exercisable. |