FUTCH ROGER 5

5 · APPALACHIAN BANCSHARES INC · Filed Apr 22, 2004

Form 5

Period: 2003-12-31

Director

Transactions

Exercise/Conversion
Common Stock
[F1]
2003-01-08$3.64/sh+38,720$140,941→ 93,755 total
Purchase
Common Stock
[F4][F5][F1]
1998-08-08+0→ 880 total(indirect: Held jointly with son)
Purchase
Common Stock
[F4][F5][F1][F2]
1998-08-08+0→ 8,140 total(indirect: By Spouse)
Purchase
Common Stock
[F4][F5][F1][F2]
1998-08-08+0→ 2,612 total(indirect: As custodian for Erin Chatham)
Purchase
Common Stock
[F4][F5][F1][F2]
1998-08-08+0→ 2,550 total(indirect: As custodian for Abigail Chatham)
Purchase
Common Stock
[F4][F5][F1][F2]
1998-08-08+0→ 2,518 total(indirect: As custodian for Amanda Futch)
Purchase
Common Stock
[F4][F5]
1998-08-08+0→ 2,000 total(indirect: As custodian for Jessica Futch)
Exercise/Conversion
Stock Option (Right to Buy)
[F1][F3]
2003-01-08−38,720→ 0 total
Exercise: $3.64From: 1998-06-01Exp: 2007-06-01→ Common Stock (38,720 underlying)

Footnotes (5)

[F1]All share amounts and exercise price values have been adjusted to reflect a 2 for 1 stock split on May 18, 1998, a separate 2 for 1 stock split on May 16, 2000, and a 10% stock dividend on July 1, 2003.
[F2]The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
[F3]The stock options, granted June 1, 1997, became exercisable in five equal annual installments of 9,680 shares (as adjusted), beginning on June 1, 1998.
[F4]This row reflects indirect ownership which has not changed as a result of the transaction reported on this form.
[F5]Dummy entry as required by software error.

Signature

/s/ W. Thomas King, pursuant to a power of attorney|2004-04-22

Documents

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