SEC Form 4 · accession 0001593968-19-000701
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
Mar 5, 2019
Accepted (ET)
Mar 7, 2019 · 4:50 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 Stock | Mar 5, 2019 | P | 351 | $13.7198 | A | 351 | I | 401(k) |
| Common Stock | Mar 6, 2019 | P | 202 | $13.7344 | A | 202 | I | 401(k) |
| 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 | |
| Common StockF1 | holding | — | — | — | 500 | D |
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,F5 | — | Mar 5, 2019 | A | 1,285 | A | — | — | ICCH Common Stock | 1,285 | 1,285 | D |
| Restricted Stock UnitF3,F4,F5 | $0.00 | holding | — | — | — | — | — | ICC Holdings, Inc. Common Stock | 1,000 | 1,000 | D |
Explanation of responses
- F1RSU with 3 Year Periodic vesting schedule
- F2Each restricted stock unit represents a contingent right to receive one share of ICCH common stock.
- F3No exercise price for this type of award
- F4No exercisable date for this type of award
- F5No expiration date for this type of award