U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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(f) of the Investment Company Act of 1940
[_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person*
Fuller Lynn B.
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(Last) (First) (Middle)
960 Prince Phillip Dr.
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(Street)
Dubuque IA 52003
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(City) (State) (Zip)
Heartland Financial USA, Inc.
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2. Issuer Name and Ticker or Trading Symbol
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
February 14, 2003
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4. Statement for Month/Year
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
President & CEO
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7. 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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6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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Common Stock 2/14/03 M 24,000 A 14.75 296,195 D Trust(3)
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Common Stock 14,000 I Partnership
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Common Stock 4,000 I By Spouse(2)
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Common Stock 769.185* I Son(2)
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Common Stock 77,848 I As Trustee(2,4)
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Common Stock 66.790* I Son(1)
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Common Stock 555 I IRA
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* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Response) (Over)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Non-Qualified
Stock Option Common
(Right to Buy) 14.75 2-14-03 M 24,000 (1) 1-02-2008 Stock 24,000 0 D
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Non-Qualified
Stock Option Common
(Right to Buy) 18.00 (1) 1-02-2009 Stock 24,000 D
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Non-Qualified
Stock Option Common
(Right to Buy) 18.00 (1) 2-17-2010 Stock 9,000 D
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Non-Qualified
Stock Option Common
(Right to Buy) 13.00 (1) 6-01-2011 Stock 10,000 D
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Non-Qualified
Stock Option Common
(Right to Buy) 13.20 (1) 1-15-2012 Stock 5,500 D
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Non-Qualified
Stock Option Common
(Right to Buy) 17.76 (1) 1-21-2013 Stock 10,000 D
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Explanation of Responses:
(1)Represents options to buy granted under the Company's 1993
Stock Option Plan, a Rule 16(b)(3) plan, which options vest
one-third per year beginning on the 3rd anniversary of date of grant.
(2)The reporting person disclaims beneficial ownership of these
securities, and this report shall not be deemed to be an admission that
the reporting person is the beneficial owner of such securities for
purposes of Section 16 or any other purpose.
(3)Shares held by Lynn B. Fuller Trust Under Agreement dated 5-7-96,
Lynn B. Fuller Trustee
(4)Shares held by the Emmo O. Fuller Trust dated 9-3-85 Dubuque Bank & Trust,
L.S. Fuller & L.B. Fuller, co-trustees
*Shares participate in a Dividend Reinvestment Plan.
/s/ Lynn B. Fuller 2/14/03
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**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal
Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.
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