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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 | ||||||||
Incentive Stock Option (right to buy) | $ 11.9063 | 01/19/2005 | X | 3,916 | 06/22/2001(4) | 12/20/2010 | Common Stock | 3,916 | $ 11.9063 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KELLEY FERDINAND T C/O INDEPENDENT BANK CORP 288 UNION STREET ROCKLAND, MA 02370 |
Executive Vice President |
Linda M. Campion, Power of Attorney for Ferdinand T. Kelley | 01/21/2005 | |
**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) | Shares held i/n/o The Ferdinand T. Kelley Revocable Living Trust (dated December 29, 2004) on which Filer is a trustee and spouse is a beneficiary. |
(2) | Total holdings include 40.53 shares received pursuant to the Company's Dividend Reinvestment Plan since the last Form 4 filing (12/04). Such transactions are exempt from the reporting requirements of Section 16 of the Securities and Exchange Act of 1934, as amended. |
(3) | Shares held jt. w/spouse and include 0.4900 shares received pursuant to the Company's Dividend Reinvestment Plan since the last Form 4 filing (12/04). Such transactions are exempt from the reporting requirements of Section 16 of the Securities and Exchange Act of 1934, as amended. |
(4) | Granted under the Independent Bank Corp. 1997 Employee Stock Option Plan (1997 Plan). 3,859 shares pursuant to the Option shall first become exercisable on 6/22/01,3,859 shares shall first become exercisable on 1/2/02, and the remaining 3,857 shares shall first become exercisable on 1/2/03. The Option will expire on 12/20/10, subject to the earlier termination of employment or acceleration of vesting schedule under certain termination of employee circumstances. |