U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF 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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
HENTHORN MARY M.
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(Last) (First) (Middle)
501 W. NORTH AVENUE
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(Street)
MELROSE PARK IL 60160
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
3/01/00
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
MIDWEST BANC HOLDINGS, INC. (MBHI)
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
PRESIDENT-MIDWEST BANK
A WHOLLY OWNED SUBSIDIARY
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6. If Amendment, Date of Original (Month/Day/Year)
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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 Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 4)
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<S> <C> <C> <C>
COMMON STOCK, PAR VALUE $.01 3,200 D
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* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Over)
(Form 3-07/98)
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FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
EMPLOYEE STOCK OPTION (RIGHT TO BUY) (1) 12/17/06 COMMON STOCK, PAR VALUE $.01 6,000 8.13 D
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EMPLOYEE STOCK OPTION (RIGHT TO BUY) (2) 12/9/07 COMMON STOCK, PAR VALUE $.01 3,000 12.75 D
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EMPLOYEE STOCK OPTION (RIGHT TO BUY) (3) 4/7/08 COMMON STOCK, PAR VALUE $.01 8,000 17.88 D
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EMPLOYEE STOCK OPTION (RIGHT TO BUY) IMMED. 1/27/09 COMMON STOCK, PAR VALUE $.01 2,176 15.88 D
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EMPLOYEE STOCK OPTION (RIGHT TO BUY) (4) 4/14/09 COMMON STOCK, PAR VALUE $.01 3,000 16.13 D
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EMPLOYEE STOCK OPTION (RIGHT TO BUY) IMMED. 1/28/10 COMMON STOCK, PAR VALUE $.01 2,705 13.63 D
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</TABLE>
Explanation of Responses:
(1) OPTIONS VEST IN FOUR EQUAL ANNUAL INSTALLMENTS BEGINNING DECEMBER 17, 1997.
(2) OPTIONS VEST IN FOUR EQUAL ANNUAL INSTALLMENTS BEGINNING DECEMBER 9, 1998.
(3) OPTIONS VEST IN FOUR EQUAL ANNUAL INSTALLMENTS BEGINNING APRIL 7, 1999.
(4) OPTIONS VEST IN FOUR EQUAL ANNUAL INSTALLMENTS BEGINNING APRIL 14, 2000.
/s/ Edward H. Sibbald 4/10/00
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**Signature of Reporting Person Date
EDWARD H. SIBBALD, SENIOR VICE PRESIDENT AND CFO,
ON BEHALF OF MARY HENTHORN
** 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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