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UNITED STATES
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(h) of the Investment Company Act of 1940
1. | Name and Address of Reporting Person* (Last, First, Middle) |
2. | Date of Event Requiring Statement (Month/Day/Year) |
3. | I.R.S. Identification Number of Reporting Person, if an entity (voluntary) |
||||
Scott, James R.
|
|
|
|||||||
2244 Stoney Ridge Road
(Street) |
4. | Issuer Name and Ticker or Trading Symbol | 5. | Relationship of Reporting Person(s) to Issuer (Check All Applicable) |
|||||
First Interstate BancSystem, Inc. (no ticker or trading symbol)
|
x
Director x 10% Owner |
o
Officer
(give title below) o Other (specify below) |
|||||||
Billings, MT 59106
(City)
(State) (Zip) |
6. | If Amendment, Date of Original (Month/Day/Year) |
|
||||||
4/15/02
|
7. | Individual or Joint/Group Filing (Check Applicable Line) |
|||||||
x
Form filed by One Reporting Person o Form filed by More than One Reporting Person |
|||||||||
* | 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. |
Table I Non-Derivative Securities Beneficially Owned | |||||||||
1. | Title of Security (Instr. 4) |
2. | Amount of Securities Beneficially Owned (Instr. 4) |
3. | Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
4. | Nature of Indirect Beneficial Ownership (Instr. 5) |
||
Common Stock | 660,663 | I | By Self as Co-Trustee | ||||||
Common Stock | 4,441 | I | By 401(K) Plan | ||||||
Common Stock | 2,850 | I | By Spouse | ||||||
Common Stock | 560,068 | I | By Self as Managing Partner | ||||||
Common Stock | 8,810 | I | By Self as President of Family Foundation | ||||||
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Table II Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||
1. | Title of Derivative Security (Instr. 4) |
2. | Date Exercisable and Expiration Date (Month/Day/Year) |
3. | Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. | Conversion or Exercise Price of Derivative Security |
5. | Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. | Nature of Indirect Beneficial Ownership (Instr. 5) |
||
Date Exer- cisable |
Expi- ration Date |
Title |
Amount or Number of Shares |
||||||||||
Stock Option | 2/19/02 | 3/15/09 | Common Stock | 110 | 42.00 | D | N/A | ||||||
Stock Option | 2/19/02 | 5/31/10 | Common Stock | 834 | 42.00 | D | N/A | ||||||
Explanation of Responses:
/s/ Terrill R. Moore | 1/31/03 | |
Attorney in Fact for Reporting Person |
Date |
** | 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 is insufficient, see Instruction 6 for procedure. | |
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