SEC Form 5 · accession 0000034782-17-000030
1ST SOURCE CORP · SRCE
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Andrea G Short
Officer — Treasurer and CFO
Period of report
Dec 31, 2016
Accepted (ET)
Feb 14, 2017 · 2:13 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000034782
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jun 22, 2016 | G | 2,200 | $0.00 | A | 2,200 | I | By Trust |
| Common StockF2 | holding | — | — | — | 33,711 | D | ||
| Common Stock | holding | — | — | — | 4,994 | I | By 401(k) |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On June 22, 2016, Ms. Short became co-trustee of a living trust in which she holds a remainder interest. Ms. Short disclaims beneficial ownership of the reported securities except to the extent of her pecuniary interest therein.
- F2Excludes 3,099 shares acquired by Ms. Short, which were reported on a Form 4 filed on February 9, 2017.