SEC Form 4 · accession 0001593968-19-000533
ICC Holdings, Inc. · ICCH
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael R. Smith
Officer — Chief Financial Officer
Period of report
Feb 20, 2019
Accepted (ET)
Feb 21, 2019 · 5:01 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001681903
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Feb 20, 2019 | M | 500 | $13.38 | A | 500 | D | |
| Common Stock | holding | — | — | — | 10,500 | I | 401(k) | |
| Common Stock | holding | — | — | — | 8,300 | I | IRA | |
| Common Stock | holding | — | — | — | 710 | I | By ESOP | |
| Common Stock | holding | — | — | — | 1,400 | I | 401(k) | |
| Common Stock | holding | — | — | — | 795 | I | By ESOP |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Restricted Stock UnitF2,F3,F4 | $0.00 | Feb 20, 2019 | M | 500 | D | — | — | ICC Holdings, Inc. Common Stock | 500 | 1,000 | D |
Explanation of responses
- F1RSU with 3 Year Periodic vesting schedule
- F2No exercise price for this type of award
- F3No exercisable date for this type of award
- F4No expiration date for this type of award