SEC Form 4 · accession 0000905729-15-000324

CHOICEONE FINANCIAL SERVICES INC · COFS

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — Sr. V.P. ChoiceOne Bank (Sub.)

Period of report

Aug 3, 2015

Accepted (ET)

Nov 20, 2015 · 5:06 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000803164

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2,F3,F4	Aug 3, 2015	F	62	$22.75	D	2,372	D
Common Stock	Nov 18, 2015	M	500	$18.85	A	2,872	D
Common Stock	Nov 18, 2015	F	387	$24.37	D	2,485	D
Common Stock	holding	—	—		—	126	I	401(k) Plan

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Stock Option (Right to Buy)	$18.85	Nov 18, 2015	M	125	D	Jan 18, 2006	Jan 17, 2016	Common	125	D
Stock Option (Right to Buy)	$18.85	Nov 18, 2015	M	125	D	Jan 18, 2007	Jan 17, 2016	Common	125	D
Stock Option (Right to Buy)	$18.85	Nov 18, 2015	M	125	D	Jan 18, 2008	Jan 17, 2016	Common	125	D
Stock Option (Right to Buy)	$18.85	Nov 18, 2015	M	125	D	Jan 18, 2009	Jan 17, 2016	Common	125	D

F1Shares forfeited upon conversion of stock units granted on August 1, 2014 to common stock.
F2The number of shares in column 5 is the reporting person's best estimate based on a plan statement dated December 31, 2014.
F3Column 5 reflects the acquisition of 28.8051 shares under the ChoiceOne Financial Services, Inc. Employee Stock Purchase Plan and 18.9212 shares from the reinvestment of cash dividends.
F4Correction of 52 certificate shares added in twice on the 4/15/15 filing.