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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 at End of Issuer's Fiscal Year (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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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MURPHY CHRISTOPHER J III PO BOX 1602 SOUTH BEND, IN 46634 |
 X |  X |  Chairman, CEO |  |
/s/ John B. Griffith, Attorney-in-Fact | 03/11/2016 | |
**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) | On July 22, 2015, 1st Source Corporation declared a 10% stock dividend payable to all holders of record of common stock on August 15, 2015. As a result, the amount of shares of common stock held directly by Mr. Murphy increased by 48,254 shares. |
(2) | On July 22, 2015, 1st Source Corporation declared a 10% stock dividend payable to all holders of record of common stock on August 15, 2015. As a result, the amount of shares of common stock held indirectly by spouse increased by 118,159 shares. Mr. Murphy disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that Mr. Murphy is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. |
(3) | Mrs. Murphy acquired the power to direct the trustee with respect to the disposition of these shares of common stock held by certain trusts for the benefit of her family line upon her appointment as the family designated representative to such trusts effective October 8, 2015. Mr. Murphy's subsequent Form 4 filed on February 29, 2016 did not reflect these additional shares. |
(4) | Mrs. Murphy gifted 15,375 shares on December 29, 2015 instead of the 16,200 reported on Mr. Murphy's original Form 5 filing. |
(5) | Between January 1, 2015 and December 31, 2015, Mr. Murphy acquired a total of 5,761 shares of 1st Source Corporation common stock under the 401(k) Plan through normal contributions and a 10% stock dividend declared by 1st Source Corporation on July 22, 2015, payable to all holders of record of common stock on August 15, 2015. The information in this report is based on a plan statement dated as of December 31, 2015. |
(6) | The shares of 1st Source Corporation common stock held by Mr. Murphy under the 401(k) Plan were understated by one share in his original Form 5 filing and his subsequent Form 4 filed on February 29, 2016. |
(7) | On July 22, 2015, 1st Source Corporation declared a 10% stock dividend payable to all holders of record of common stock on August 15, 2015. As a result, the amount of shares of common stock held by Mr. Murphy indirectly by corporation increased by 11,444 shares. |
(8) | On July 22, 2015, 1st Source Corporation declared a 10% stock dividend payable to all holders of record of common stock on August 15, 2015. As a result. the amount of shares of common stock held by Mr. Murphy indirectly by ERCO II Partnership increased by 39,830 shares, the amount of shares held indirectly by ERCO III Partnership increased by 25,647 shares, and the amount of shares held indirectly by Ltd. Partnership increased by 19,524 shares. Mr. Murphy disclaims beneficial ownership of those shares held by the partnership exceeding his pecuniary interest, and this report shall not be deemed an admission that Mr. Murphy is the beneficial owner of such excess shares for purposes of Section 16 or for any other purpose. |
(9) | On July 22, 2015, 1st Source Corporation declared a 10% stock dividend payable to all holders of record of common stock on August 15, 2015. As a result, the amount of shares of common stock held by Mr. Murphy indirectly by LLC increased by 53,145 shares. Mr. Murphy's spouse is a voting member, and Mr. Murphy is a non-voting member, of the LLC. Mr. Murphy disclaims beneficial ownership of those shares held by the LLC exceeding his pecuniary interest, and this report shall not be deemed an admission that Mr. Murphy is the beneficial owner of such excess shares for purposes of Section 16 or for any other purpose. |