SEC FORM 5 SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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).
Form 3 Holdings Reported.
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
FORSYTHE DARYL R

(Last) (First) (Middle)
52 SOUTH BROAD STREET

(Street)
NORWICH NY 13815

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
NBT BANCORP INC [ NBTB ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President/CEO NBT Bancorp
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2003
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 at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
NBT Bancorp Inc. Common Stock 12/31/2003 J 1,410.421 A $15.0664(1) 74,103.833 D
NBT Bancorp Inc. Common Stock 12/31/2003 J 1,839.959 A (2) 75,943.792 D
NBT Bancorp Inc. Common Stock 12/31/2003 J 1,014.712 A (3) 8,171.899 I 401k
NBT Bancorp Inc. Common Stock 12/31/2003 J 293.081 A (4) 2,758.846 I NBT Bancorp ESOP
NBT Bancorp Inc. Common Stock 1,511 I by Spouse
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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Non-Qualified Stock Option (right to buy) $14.3492 01/28/2003(5) 01/28/2012 NBT Bancorp Inc. Common Stock 52,300 52,300 D
Non-Qualified Stock Option (right to buy) $14.88 01/24/2001(5) 01/24/2010 NBT Bancorp Inc. Common Stock 50,400 50,400 D
Non-Qualified Stock Option (right to buy) $16.0625 01/22/2002(5) 01/22/2011 NBT Bancorp Inc. Common Stock 54,500 54,500 D
Non-Qualified Stock Option (right to buy) $17.538 01/01/2004(5) 01/01/2013 NBT Bancorp Inc. Common Stock 36,375 36,375 D
Non-Qualified Stock Option (right to buy) $18.1632 01/27/1999(5) 01/27/2008 NBT Bancorp Inc. Common Stock 41,306.99 41,306.99 D
Non-Qualified Stock Option (right to buy) $19.7917 08/11/2005(6) 08/11/2013 NBT Bancorp Inc. Common Stock 5,200 5,200 D
Non-Qualified Stock Option (right to buy) $19.7925 08/14/2005(6) 08/14/2013 NBT Bancorp Inc. Common Stock 6,050 6,050 D
Non-Qualified Stock Option (right to buy) $19.8125 08/12/2005(6) 08/12/2013 NBT Bancorp Inc. Common Stock 11,700 11,700 D
Non-Qualified Stock Option (right to buy) $20.0558 08/05/2005(6) 08/05/2013 NBT Bancorp Inc. Common Stock 4,000 4,000 D
Non-Qualified Stock Option (right to buy) $20.441 04/28/2001(6) 04/28/2009 NBT Bancorp Inc. Common Stock 10,500 10,500 D
Non-Qualified Stock Option (right to buy) $20.5952 01/26/2000(5) 01/26/2009 NBT Bancorp Inc. Common Stock 36,435 36,435 D
Explanation of Responses:
1. Shares were acquired pursuant to the NBT Bancorp Inc. Section 423 Employee Stock Purchase Plan.
2. Shares acquired under NBT Bancorp Dividend Reinvestment Plan during period of January 1 to December 31, 2003 at prices ranging from $17.9402 to $21.8976 per share.
3. Shares were purchased from 1/1/2003 through 12/31/2003 through NBT Bancorp Inc. 401k Plan.
4. Shares were purchased from 1/1/2003 through 12/31/2003 through NBT Bancorp Inc. ESOP Plan.
5. Pursuant to NBT Bancorp Inc. 1993 Stock Option Plan grant vests 40% for first year, 20% annually for following years.
6. Pursuant to NBT Bancorp Inc. 1993 Stock Option Plan reload grant vests 100% two years after date of its grant.
By: Michael J. Chewens, Power of Attorney For: Daryl R. Forsythe 01/27/2004
** 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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