SEC Form 4 · accession 0000899243-17-000204
HICKOK INC · HICKA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Steven Rosen
Director · 10% Owner
Period of report
Dec 20, 2016
Accepted (ET)
Jan 4, 2017 · 2:55 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000047307
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class A Common StockF3 | holding | — | — | — | 320,918 | I | See Footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrant to Purchase Class A Common StockF1,F3 | $2.50 | Dec 20, 2016 | D | 100,000 | D | — | Dec 30, 2016 | Class A Common Stock | 100,000 | 252,367 | I |
| Warrant to Purchase Class A Common StockF1,F3 | $2.50 | Dec 20, 2016 | A | 100,000 | A | — | Dec 30, 2017 | Class A Common Stock | 100,000 | 352,367 | I |
| Convertible Loan AgreementF2,F3 | $1.85 | Dec 20, 2016 | D | 252,367 | D | — | Dec 30, 2016 | Class A Common Stock | 252,367 | 100,000 | I |
| Convertible Loan AgreementF2,F3 | $1.85 | Dec 20, 2016 | A | 252,367 | A | — | Dec 30, 2017 | Class A Common Stock | 252,367 | 352,367 | I |
| Class A Common Stock Option | $2.925 | holding | — | — | — | Mar 8, 2012 | Mar 8, 2022 | Class A Common Stock | 1,000 | 1,000 | D |
Explanation of responses
- F1The two reported transactions involved an amendment of an outstanding warrant, resulting in the deemed cancellation of the "old" warrant and the grant of a replacement warrant.
- F2The two reported transactions involved an amendment of an outstanding convertible loan agreement, resulting in the deemed cancellation of the "old" convertible loan agreement and the entry into a replacement convertible loan agreement.
- F3The securities reported herein are owned directly by Roundball, LLC, an Ohio limited liability company. For purposes of the Securities Exchange Act of 1934, the Reporting Person disclaims beneficial ownership of any securities, except of his pecuniary interest therein, if any, 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 otherwise.