SEC Form 5 · accession 0001209191-17-006366
City Office REIT, Inc. · CIO
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Stephen B Shraiberg
Director
Period of report
Dec 31, 2016
Accepted (ET)
Jan 31, 2017 · 4:23 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001593222
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Sep 29, 2016 | M | 582 | — | A | 58,607 | D | |
| Common StockF2 | holding | — | — | — | 2,000 | I | Family Partnership | |
| Common StockF2 | holding | — | — | — | 2,000 | I | Family Member | |
| Common StockF2 | holding | — | — | — | 2,000 | I | Spouse | |
| Common StockF2 | holding | — | — | — | 33,124 | I | Through Po-Jay LLLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Restricted Stock UnitsF1,F3 | — | Sep 29, 2016 | M | 582 | D | — | — | Common Stock | 582 | 3,190 | D |
Explanation of responses
- F1In accordance with the Company's Equity Incentive Plan (the "Equity Incentive Plan"), Restricted Stock Units (as defined in the Equity Incentive Plan) convert into common stock on a one-for-one basis.
- F2The Reporting Person disclaims beneficial ownership of these securities as this report shall not be deemed an admission that the Reporting Person is the beneficial owner of these securities for the purposes of Section 16 or any other purpose.
- F3The restricted stock units reported herein have vested and converted to common shares as at September 29, 2016.