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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 | ||||||||
2013 Time-Based Restricted Stock | (6) | (7) | (7) | Common Stock | 3,850 | $ 0 | D | ||||||||
2013 Time-Based Restricted Stock | (6) | 01/20/2017 | 01/23/2017 | F | 1,925 | (7) | (7) | Common Stock | 1,925 | $ 0 | $ 0 | D | |||
2014 Time-Based Restricted Stock | (6) | (8) | (8) | Common Stock | 5,200 | $ 0 | D | ||||||||
2015 Performance Based Restricted Stock | (6) | (9) | (9) | Common Stock | 3,500 | $ 0 | D | ||||||||
2015 Time-Based Restricted Stock | (6) | (10) | (10) | Common Stock | 5,000 | $ 0 | D | ||||||||
2016 Performance Based Restricted Stock (1-year performance) | (6) | (11) | (11) | Common Stock | 5,300 | 0 | D | ||||||||
2016 Performance Based Restricted Stock (3-year performance) | (6) | (12) | (12) | Common Stock | 2,524 | $ 0 | D | ||||||||
2016 Time-Based Restricted Stock | (6) | (13) | (13) | Common Stock | 4,760 | 0 | D | ||||||||
2016 Time-Based Restricted Stock | (6) | 01/19/2017 | F | 1,587 | (13) | (13) | Common Stock | 3,173 | $ 0 | $ 0 | D | ||||
2017 Time-Based Restricted Stock | (6) | (14) | (14) | Common Stock | 3,455 | $ 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
FULLER LYNN B 1398 CENTRAL AVE. DUBUQUE, IA 52001 |
X | Chairman & CEO |
/s/ Lynn B. Fuller | 01/23/2017 | |
**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) | These shares are held by Lynn B. Fuller Trust Under Agreement dated 5-7-96, Lynn B. Fuller Trustee |
(2) | These shares are held by Cynthia A Fuller Declaration of Trust under agreement dated 7/2/2015, Cynthia A Fuller, Trustee |
(3) | These shares are held by LBF Heartland Partnership LLLC - Lynn B Fuller is the General Partner. Wife and two (2) adult sons are Limited Partners. |
(4) | These shares held by Emma O. Fuller Trust dated 9-3-85 Dubuque Bank & Trust, Lynn B Fuller, Trustee |
(5) | Represents shares allocated to the reporting person's account under the Heartland Financial USA, Inc. Retirement Plan as a result of the Pension Plan Protectin Act of 2006. |
(6) | Each restricted stock unit represents a contingent right to receive one share of Issuer's common stock. |
(7) | Of these restricted stock units, 1/3 vest on 1-22-2016, 1/3 vest on 1-22-2017, and 1/3 vest on 1-22-2018. |
(8) | Of these restricted stock units, 1/3 vest on 3-11-2017, 1/3 vest on 3-11-2018, and 1/3 vest on 3-11-2019. |
(9) | These restricted stock units vest on 1-18-2018 if certain performance measures are achieved by the Issuer. |
(10) | Of these restricted stock units, 1/3 vest on 1-20-2018, 1/3 vest on 1-20-2019, and 1/3 vest on 1-20-2020. |
(11) | These restricted stock units vest on 1-19-2019 if certain performance measures are achieved by the Issuer. |
(12) | These restricted stock units vest in 2019 if certain performance measures are achieved by the Issuer. |
(13) | Of these restricted stock units, 1/3 vest on 1-19-2017, 1/3 vest on 1-19-2018, and 1/3 vest on 1-19-2019. |
(14) | Of these restricted stock units, 1/3 vest in 01-2018, 1/3 vest in 01-2019 and 1/3 vest in 01-2020. |