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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 1)*
NorthWest Indiana Bancorp
Common Stock, Par Value $1.00 Per
Share
667516108
December 31, 2003
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
o Rule 13d-1 (b)
x Rule 13d-1 (c)
o Rule 13d-1 (d)
*The remainder of this cover page shall be filled out for a
reporting persons initial filing on this form with respect to the subject
class of securities, and for any subsequent amendment containing information
which would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page
shall not be deemed to be filed for the purpose of Section 18
of the Securities Exchange Act of 1934 or otherwise subject to the liabilities
of that section of the Act but shall be subject to all other provisions of the
Act (however, see the notes).
13G | ||||||
CUSIP No. 667516108 | ||||||
1. | Name of Reporting
Person: David A. Bochnowski |
I.R.S. Identification Nos. of above
persons (entities only): Not applicable |
||||
2. | Check the Appropriate Box if a Member of a Group: | |||||
(a) | x | |||||
(b) | o | |||||
3. | SEC Use Only: | |||||
4. | Citizenship or Place of
Organization: U.S. Citizen |
|||||
Number
of Shares Beneficially Owned by Each Reporting Person With | ||||||
5. | Sole Voting Power: 17,380 | |||||
6. | Shared Voting Power: 244,991 | |||||
7. | Sole Dispositive Power: 55,024 | |||||
8. | Shared Dispositive Power: 244,991 | |||||
9. | Aggregate Amount Beneficially Owned by Each Reporting Person:
300,015 |
|||||
10. | Check if the Aggregate Amount in Row (9) Excludes Certain
Shares: o |
|||||
11. | Percent of Class Represented by Amount in Row (9): 10.9% of the 2,754,068 shares outstanding as of December 31, 2003 | |||||
12. | Type of Reporting Person: IN | |||||
13G | ||||||
CUSIP No. 667516108 | ||||||
1. | Name of Reporting Person: Ann M. Bochnowski |
I.R.S. Identification Nos. of above
persons (entities only): Not applicable |
||||
2. | Check the Appropriate Box if a Member of a Group: | |||||
(a) | x | |||||
(b) | o | |||||
3. | SEC Use Only: | |||||
4. | Citizenship or Place of
Organization: U.S. Citizen |
|||||
Number
of Shares Beneficially Owned by Each Reporting Person With | ||||||
5. | Sole Voting Power: 0 | |||||
6. | Shared Voting Power: 244,991 | |||||
7. | Sole Dispositive Power: 0 | |||||
8. | Shared Dispositive Power: 244,991 | |||||
9. | Aggregate Amount Beneficially Owned by Each Reporting Person:
244,991 |
|||||
10. | Check if the Aggregate Amount in Row (9) Excludes Certain
Shares: o |
|||||
11. | Percent of Class Represented by Amount in Row (9): 8.9% of the 2,754,068 shares outstanding as of December 31, 2003 | |||||
12. | Type of Reporting Person: IN | |||||
This filing constitutes an amendment of the Schedule 13G filed on November 7, 2003 (the Initial Schedule 13G). The purpose of this amendment is to reflect changes in the beneficial ownership of the reporting persons since the filing of the Initial Schedule 13G.
Item 1
(a) | Name of Issuer. | |||
NorthWest Indiana Bancorp | ||||
(b) | Address of Issuers Principal Executive Offices. | |||
9204 Columbia Avenue, Munster, Indiana 46321 | ||||
Item 2 |
||||
This Schedule is being jointly filed by each of the following persons pursuant to Rule 13d-1(k)(1). The filing persons have entered into a Joint Filing Agreement, a copy of which is filed with this Schedule as Exhibit 1 | ||||
1. |
(a) | Name of Person Filing. | ||
David A. Bochnowski | ||||
(b) | Address of Principal Business Office, or, if none, Residence. | |||
10203 Cherrywood Lane, Munster, Indiana 46321 | ||||
(c) | Citizenship. | |||
U.S. Citizen | ||||
(d) | Title of Class of Securities. | |||
Common Stock, par value $1.00 per share | ||||
(e) | CUSIP Number. 667516108 |
|||
2. |
(a) | Name of Person Filing. | ||
Ann M. Bochnowski | ||||
(b) | Address of Principal Business Office, or, if none, Residence. | |||
10203 Cherrywood Lane, Munster, Indiana 46321 | ||||
(c) | Citizenship. | |||
U.S. Citizen | ||||
(d) | Title of Class of Securities. | |||
Common Stock, par value $1.00 per share | ||||
(e) | CUSIP Number. 667516108 |
Item 3. If this statement is filed pursuant to Sections 240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:
(a) |
[ ] | Broker or dealer registered under Section 15 of the Act; | ||
(b) |
[ ] | Bank as defined in Section 3(a)(6) of the Act; | ||
(c) |
[ ] | Insurance Company as defined in Section 3(a)(19) of the Act; | ||
(d) |
[ ] | Investment Company registered under Section 8 of the Investment Company Act of 1940; | ||
(e) |
[ ] | An investment adviser in accordance with Section 240.13d-1(b)(1)(ii)(E); | ||
(f) |
[ ] | An employee benefit plan or
endowment fund in accordance with Section 240.13d-1(b)(1)(ii)(F); |
||
(g) |
[ ] | A parent holding company or control
person in accordance with Section 240.13d-1(b)(1)(ii)(G); |
||
(h) |
[ ] | A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act; | ||
(i) |
[ ] | A church plan that is excluded from the definition of an investment company under Section 3(c)(14) of the Investment Company Act of 1940; | ||
(j) |
[ ] | Group, in accordance with Section 240.13d-1(b)(1)(ii)(J). |
If this Statement is filed pursuant to Rule 13d-1(c), check this box: [ X ]
Item 4. Ownership.
Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1.
1. | The following information is provided for David A. Bochnowski as of December 31, 2003 | |||||
(a) | Amount beneficially owned: 300,015 |
|||||
(b) | Percent of class: 10.9% |
|||||
(c) | Number of shares as to which such person has: | |||||
(i) | Sole power to vote or direct the vote: 17,380 |
|||||
(ii) | Shared power to vote or to direct the vote: 244,991 |
|||||
(iii) | Sole power to dispose or to direct the disposition of: 55,024 |
|||||
(iv) | Shared power to dispose or to direct the disposition of: 244,991 |
|||||
2. | The following information is provided for Ann M. Bochnowski as of December 31, 2003 | |||||
(a) | Amount beneficially owned: 244,991 |
|||||
(b) | Percent of class: 8.9% |
|||||
(c) | Number of shares as to which such person has: | |||||
(i) | Sole power to vote or direct the vote: 0 |
|||||
(ii) | Shared power to vote or to direct the vote: 244,991 |
(iii) | Sole power to dispose or to direct the disposition of: 0 |
|||||
(iv) | Shared power to dispose or to direct the disposition of: 244,991 |
As of December 31, 2003, Mr. Bochnowski was deemed to beneficially own 300,015 shares of common stock, which represented 10.9% of the 2,754,068 common shares outstanding as of December 31, 2003. This amount included (i) 17,380 shares to which Mr. Bochnowski has sole voting and dispositive power; (ii) 37,644 shares allocated to Mr. Bochnowski under the Employees Savings and Profit Sharing Plan and Trust as to which Mr. Bochnowski only has dispositive power; (iii) 176,345 shares as to which Mr. Bochnowski and his spouse have shared voting and dispositive power; (iv) 42,246 shares as to which Mr. Bochnowskis spouse has voting and dispositive power; and (v) 26,400 shares owned by Mr. Bochnowskis minor children for which his spouse is custodian or trustee. Mr. Bochnowski continues to claim beneficial interest in the shares owned by his spouse or controlled by her as trustee or custodian. Mr. Bochnowskis beneficial ownership reported in (i) above includes stock options representing 6,775 shares which were exercisable at December 31, 2003 or within sixty days from such date. Such shares have been added into the total shares outstanding at December 31, 2003 for purposes of determining Mr. Bochnowskis percentage ownership.
Item 5. Ownership of Five Percent or Less of a Class.
If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following [ ].
Item 6. Ownership of More than Five Percent on Behalf of
Another Person
Not applicable
Item 7. Identification and Classification of the Subsidiary Which Acquired the
Security
Being Reported on By the Parent Holding Company or Control
Person.
Not applicable
Item 8. Identification and Classification of Members of the Group.
David Bochnowski and his spouse, Ann Bochnowski, share beneficial ownership of some of the same shares of the Issuers common stock and otherwise act together with respect to the voting and disposition of their ownership in the Issuer. As a result, they constitute a group
for purposes of this Schedule and have jointly filed this Schedule pursuant to Rule 13d-1(k)(1). A copy of their Joint Filing Agreement is attached to this Schedule as Exhibit 1.
Item 9. Notice
of Dissolution of Group.
Not applicable
Item 10. Certification.
By signing below, each of the undersigned certify that, to the best of their knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the Issuer of the securities and were not acquired and are not held in connection with or as a participation in any transaction having that purpose or effect.
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, the undersigned certify that the information set forth in this statement is true, complete and correct.
Dated: February 13, 2004 | |||||
/s/ David A. Bochnowski David A. Bochnowski |
|||||
/s/ Ann M. Bochnowski Ann M. Bochnowski |
EXHIBIT 1
JOINT FILING AGREEMENT
In accordance with Rule 13d-1(k) under the Securities Exchange Act of 1934, as amended, the undersigned hereby acknowledge and agree that the Statement on Schedule 13G (the Schedule 13G) with respect to the securities of NorthWest Indiana Bancorp, to which this Agreement is attached, is filed on behalf of each of the undersigned and that all subsequent amendments to the Schedule 13G shall be filed on behalf of each of the undersigned without the necessity of filing additional joint filing agreements. The undersigned acknowledge that each shall be responsible for the timely filing of such amendments, and for the completeness and accuracy of the information concerning him or her contained herein, but shall not be responsible for the completeness and accuracy of the information concerning the other persons, except to the extent that he or she knows or has reason to believe that such information is inaccurate. This Agreement may be executed in any number of counterparts, all of which taken together shall constitute one and the same instrument.
IN WITNESS WHEREOF, the undersigned hereby execute this Agreement this 13th day of February 2004.
/s/ David A. Bochnowski David A. Bochnowski |
||||
/s/ Ann M. Bochnowski Ann M. Bochnowski |