UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
( ) Check this box if no longer subject to Section 16. Form 4 or
Form 5 obligations may continue. See Instructions 1(b).
(X) Form 3 Holdings Reported.
(X) Form 4 Transactions Reported.
1. Name and Address of Reporting Person:
Donald J. Straka
N53 W14147 Invery Drive
Menomonee Falls, WI 53051
2. Issuer Name and Ticker or Trading Symbol:
Central Illinois Bancorp, Inc. (not listed)
3. IRS or Social Security Number of Reporting Person (Voluntary):
4. Statement for Month/Year:
December, 1998
5. If Amendment, Date of Original (Month/Year):
6. Relationship of Reporting Person(s) to Issuer (Check all
applicable):
( ) Director ( ) 10% Owner (x) Officer (give title below) ( )
Other (specify below)
Senior Vice President, Secretary and General Counsel
7. Individual or Joint/Group Filing (Check Applicable Line):
(x) Form filed by One Reporting Person
( ) Form filed by More than One Reporting Person<PAGE>
<TABLE>
<CAPTION>
Table I -- Non-Derivative Securities Acquired,
Disposed of, or Beneficially Owned
<S> <C> <C> <C> <C> <C> <C>
5. Amount of
Securities
Beneficially 6. Owner-
2. Trans- Owned at End ship Form: 7. Nature of
action of Month Direct (D) Indirect
1. Title of Date 4. Securities Acquired (A) or In- Beneficial
Security (Month / 3. Transaction Code or Disposed of (D) (Instr. 3 and direct (I) Ownership
(Instr. 3) Day/Year) (Instr. 8) (Instr. 3, 4 and 5) 4) (Instr. 4) (Instr. 4)
----------- ---------- ------------------ ---------------------------- -------------- ---------- -------------
Code V Amount (A)or(D) Price
Common Stock 12/31/98 4 1.80 A 1.80 I By ESOP
Common Stock 3 (1) 32 (1) 32 (1) I By SIG, a
general
partnership
/TABLE
<PAGE>
<TABLE>
Table II -- Derivative Securities Acquired,
Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
9.
Number of 10.
5. Deri- Ownership
2. Number of vative Form of
Conver- Derivative 6. Securities Deriva-
1. sion or 3. Securities Date 7. 8. Benefi- tive 11.
Title Exercise Trans- 4. Acquired (A) Exercis- Title Price cially Security: Nature
of Deri- Price of action Trans- or Disposed able and and Amount of of Deri- Owned Direct (D) of Indirect
vative Deriva- Date action of (D) Expiration Underlying vative at End of or In- Beneficial
Security tive (Month/ Code (Instr. 3, Date (Month/ Securities Security Month direct (I) Ownership
(Instr. 3) Security Day/Year) (Instr. 8) 4 and 5) Day/Year) (Instr. 3 and 4) (Instr. 5) (Instr. 4) (Instr. 4) (Instr. 4)
- ---------- -------- --------- ---------------------- ------------ ---------------- ---------- ---------- --------- ----------
Code V (A) (D) Date Expir- Title Amount or
Exer- ation Number of
cis- Date Shares
able
Employee $2,059.64 9/24/97 3 (2) (2) 9/24/07 Common 46 46 D
Stock Option Stock
(right to
buy) (2)
Employee $1,960.56 2/25/98 3 (3) (3) 2/25/08 Common 103 103 D
Stock Option Stock
(right to
buy) (3)
</TABLE>
Explanation of Responses:
(1) The reporting person's beneficial ownership in these shares was not
reported on the reporting person's Form 3, dated June 29, 1998. The
reporting person disclaims beneficial ownership of these securities
except to the extent of his pecuniary interest therein.
(2) The employee stock option dated 9/24/97 vests in five equal annual
installments which began on September 24, 1998.
(3) The employee stock option dated 2/25/98 vests in five equal annual
installments beginning on February 25, 1999.<PAGE>
SIGNATURE OF REPORTING PERSON:
Donald J. Straka
DATE: February 15, 1999
