UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
1st Source Bank, as trustee of the Irrevocable Living Trust Created by Ella L. Morris Designated as Trust No. 21-3753 dated August 20, 1965 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, as trustee of the Irrevocable Charitable Living Trust Created By Ella L. Morris Designated as Trust No. 21-3673 dtd January 22, 1965 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, as trustee of the Irrevocable Charitable Living Trust Created By Ella L. Morris Designated as Trust No. 213653 dtd December 24, 1964 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, as trustee of the Irrevocable Living Trust Created for Carmen C. Murphy by Ernestine M. Carmichael dated October 27, 1964 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, as trustee of the Irrevocable Living Trust Created for Oliver C. Carmichael III by Ernestine M. Carmichael dated October 27, 1964 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, as trustee of the Irrevocable Living Trust Created by Ella L. Morris Designated as Trust No. P-2879 dated August 6, 1960 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, T'ee of the Trusts for Oliver C. Carmichael III, Stanley C. Carmichael, Carmen C. Murphy & Ernestine C. Nickle U/A dtd 7/2/1971 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, T'ee Carmen C. Murphy Trust, Oliver C. Carmichael III Trust, Ernestine C. Nickle Trust & Stanley C. Carmichael Trust U/A dtd 10/20/59 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, T'ee Carmen C. Murphy Trust, Oliver C. Carmichael III Trust, Ernestine C. Nickle Trust & Stanley C. Carmichael Trust U/A dtd 3/22/57 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
1st Source Bank, as trustee of the irrevocable trust created by Ella L. Morris dated April 28, 1932 C/O 1ST SOURCE BANK 100 NORTH MICHIGAN STREET SOUTH BEND, IN 46601 |
 |  X |  |  |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date | |
/s/ Steven J. Wessel, Executive Vice President 1st Source Bank, Trustee | 09/17/2012 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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 Reporting Person is filing this Form 3 solely in its capacity as trustee of (i) the irrevocable trust created by Ella L. Morris dated April 28, 1932, (ii) the Carmen C. Murphy Trust, Oliver C. Carmichael III Trust, Ernestine C. Nickle Trust & Stanley C. Carmichael Trust U/A dtd 3/22/1957, (iii) the Carmen C. Murphy Trust, Oliver C. Carmichael III Trust, Ernestine C. Nickle Trust & Stanley C. Carmichael Trust U/A dtd 10/20/1959, (iv) the Irrevocable Living Trust Created by Ella L. Morris Designated as Trust No. P-2877 dated August 6, 1960, (v) the Irrevocable Living Trust Created by Ella L. Morris Designated as Trust No. P-2879 dated August 6, 1960, (vi) the Irrevocable Living Trust Created for Oliver C. Carmichael III by Ernestine M. Carmichael dated October 27, 1964, (vii) the Irrevocable Living Trust Created for Carmen C. Murphy by Ernestine M. Carmichael dated October 27, 1964, (CONTINUED ON FOOTNOTE #2) |
(2) | (CONTINUED FROM FOOTNOTE #1) (viii) the Irrevocable Charitable Living Trust Created By Ella L. Morris Designated as Trust No. 213653 dtd December 24, 1964, (ix) the Irrevocable Charitable Living Trust Created By Ella L. Morris Designated as Trust No. 21-3673 dtd January 22, 1965, (x) the Irrevocable Living Trust Created by Ella L. Morris Designated as Trust No. 21-3753 dated August 20, 1965, (x) Trust No. 11 & Trust No. 12 held under the Revocable Living Trust Created By Ella L. Morris dated October 12, 1965, (xii) the Trusts for Oliver C. Carmichael III, Stanley C. Carmichael, Carmen C. Murphy & Ernestine C. Nickle U/A dtd 7/2/1971 (collectively, the "Family Trusts"). The Reporting Person disclaims a pecuniary interest respect to the shares of Common Stock held in the Family Trusts. |
(3) | The Family Trusts are members of a group for Section 16 purposes. This report shall not be deemed to be an admission that any Reporting Person or Family Trust is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. |
(4) | Shares held by 1st Source Bank, as trustee of the Irrevocable Living Trust Created by Ella L. Morris Designated as Trust No. 21-3753 dated August 20, 1965. |
(5) | Shares held by 1st Source Bank, as trustee of the Irrevocable Charitable Living Trust Created by Ella L. Morris Designatd as Trust No. 21-3673 dtd January 22, 1965. |
(6) | Shares held by 1st Source Bank, as trustee of the Irrevocable Charitable Living Trust Created by Ella L. Morris Designated as Trust No. 213653 dtd December 24, 1964. |
(7) | Shares held by 1st Source Bank, as trustee of the Irrevocable Living Trust Created for Carmen C. Murphy by Ernestine M. Carmichael dated October 27, 1964. |
(8) | Shares held by 1st Source Bank, as trustee of the Irrevocable Living Trust Created for Oliver C. Carmichael III by Ernestine M. Carmichael dated October 27, 1964. |
(9) | Shares held by 1st Source Bank, as trustee of the Irrevocable Living Trust Created by Ella L. Morris Designated as Trust No. P-2877 dated August 6, 1960. |
(10) | Shares held by 1st Source Bank, as trustee of Trusts for Oliver C. Carmichael III, Stanley C. Carmichael, Carmen C. Murphy & Ernestine C. Nickle U/A 7/2/1971. |
(11) | Shares held by 1st Source Bank, T'ee Carmen C. Murphy Trust, Oliver C. Carmichael III Trust, Ernestine C. Nickle Trust & Stanley C. Carmichael Trust U/A dtd 10/20/1959. |
(12) | Shares held by 1st Source Bank, as trustee of the T'ee Carmen C. Murphy Trust, Oliver C. Carmichael III Trust, Ernestine C. Nickle Trust & Stanley C. Carmichael Trust U/A dtd 3/22/1957. |
(13) | Shares held by 1st Source Bank, as trustee of the irrevocable trust created by Ella L. Morris dated April 28, 1932. |