SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
DUKEMAN VAN A

(Last) (First) (Middle)
100 WEST UNIVERSITY

(Street)
CHAMPAIGN IL 61820

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FIRST BUSEY CORP /NV/ [ BUSE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President & CEO
3. Date of Earliest Transaction (Month/Day/Year)
12/03/2009
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 12/03/2009 C 100,000 A $4 262,092 D
Common Stock 4,498 I P/S Plan
Common Stock 130 I ESOP Plan
Common Stock 12/03/2009 C 31,000 A $4 53,729 I IRA'S
Common Stock 3,588 I Spouse
Common Stock 12/03/2009 C 5,750 A $4 6,604 I Spouse/IRA
Common Stock 12/03/2009 C 1,250 A $4 2,156 I Joint Custody Account
Common Stock 12/03/2009 C 12,000 A $4 12,000 I Child Custodial Accounts under IL-UTMA
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Common Stock $11.85 08/01/2007 04/12/2010 Stock Option 8,544 8,544 D
Common Stock $11.29 08/01/2007 03/20/2011 Stock Option 8,138 8,138 D
Common Stock $12 08/01/2007 03/19/2012 Stock Option 7,750 7,750 D
Common Stock $16 08/01/2007 03/18/2013 Stock Option 7,750 7,750 D
Common Stock $19.74 08/01/2007 02/17/2014 Stock Option 11,625 11,625 D
Common Stock $19.09 08/01/2007 02/15/2015 Stock Option 11,625 11,625 D
Common Stock $19.41 08/01/2007 02/21/2016 Stock Option 11,625 11,625 D
Series A Convertible Preferred Stock(1) $4 12/03/2009 C 4 (1) (1) Common 100,000 $0 0 D
Series A Convertible Preferred Stock(2) $4 12/03/2009 C 0.48 (2) (2) Common 12,000 $0 0 I Child Custodial Accounts under ILUTMA
Series A Convertible Preferred Stock(3) $4 12/03/2009 C 1.24 (3) (3) Common 31,000 $0 0 I Van A. Dukeman IRA'S
Series A Convertible Preferred Stock(4) $4 12/03/2009 C 0.23 (4) (4) Common 5,750 $0 0 I Spouse IRA
Series A Convertible Preferred Stock(5) $4 12/03/2009 C 0.05 (5) (5) Common 1,250 $0 0 I Joint Custody Account
Explanation of Responses:
1. As previously reported, on October 29, 2009, the reporting person purchased 4 shares of Series A Convertible Preferred Stock (?Preferred Stock?) from the Company. The Preferred Stock is perpetual and each share has a liquidation preference of $100,000. Pursuant to the terms of the Preferred Stock, following the required shareholder approval, the Preferred Stock is mandatorily convertible into shares of common stock at a conversion price of $4.00. On December 2, 2009, the Company?s stockholders approved the conversion of the Preferred Stock and on December 3, 2009, the Preferred Stock owned by the reporting person was converted into an aggregate of 100,000 shares of common stock.
2. As previously reported, on October 29, 2009, the reporting person purchased 0.48 shares of Series A Convertible Preferred Stock (?Preferred Stock?) from the Company. The Preferred Stock is perpetual and each share has a liquidation preference of $100,000. Pursuant to the terms of the Preferred Stock, following the required shareholder approval, the Preferred Stock is mandatorily convertible into shares of common stock at a conversion price of $4.00. On December 2, 2009, the Company?s stockholders approved the conversion of the Preferred Stock and on December 3, 2009, the Preferred Stock owned by the reporting person was converted into an aggregate of 12,000 shares of common stock.
3. As previously reported, on October 29, 2009, the reporting person purchased 1.24 shares of Series A Convertible Preferred Stock (?Preferred Stock?) from the Company. The Preferred Stock is perpetual and each share has a liquidation preference of $100,000. Pursuant to the terms of the Preferred Stock, following the required shareholder approval, the Preferred Stock is mandatorily convertible into shares of common stock at a conversion price of $4.00. On December 2, 2009, the Company?s stockholders approved the conversion of the Preferred Stock and on December 3, 2009, the Preferred Stock owned by the reporting person was converted into an aggregate of 31,000 shares of common stock.
4. As previously reported, on October 29, 2009, the reporting person purchased 0.23 shares of Series A Convertible Preferred Stock (?Preferred Stock?) from the Company. The Preferred Stock is perpetual and each share has a liquidation preference of $100,000. Pursuant to the terms of the Preferred Stock, following the required shareholder approval, the Preferred Stock is mandatorily convertible into shares of common stock at a conversion price of $4.00. On December 2, 2009, the Company?s stockholders approved the conversion of the Preferred Stock and on December 3, 2009, the Preferred Stock owned by the reporting person was converted into an aggregate of 5,750 shares of common stock.
5. As previously reported, on October 29, 2009, the reporting person purchased 0.05 shares of Series A Convertible Preferred Stock (?Preferred Stock?) from the Company. The Preferred Stock is perpetual and each share has a liquidation preference of $100,000. Pursuant to the terms of the Preferred Stock, following the required shareholder approval, the Preferred Stock is mandatorily convertible into shares of common stock at a conversion price of $4.00. On December 2, 2009, the Company?s stockholders approved the conversion of the Preferred Stock and on December 3, 2009, the Preferred Stock owned by the reporting person was converted into an aggregate of 1,250 shares of common stock.
Remarks:
/s/ Van A. Dukeman 12/07/2009
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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