SEC Form 4 · accession 0000905729-17-000121
CHOICEONE FINANCIAL SERVICES INC · COFS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Kelly Potes
Officer — President · Director
Period of report
Mar 7, 2017
Accepted (ET)
Mar 9, 2017 · 10:06 am 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 | Mar 7, 2017 | M | 1,000 | $13.50 | A | 17,153 | D | |
| Common stockF1 | holding | — | — | — | 491 | I | 401(k) Plan |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy) | $13.50 | Mar 7, 2017 | M | 250 | D | Jan 24, 2008 | Jan 23, 2018 | Common | 250 | 0 | D |
| Stock Option (Right to Buy) | $13.50 | Mar 7, 2017 | M | 250 | D | Jan 24, 2009 | Jan 23, 2018 | Common | 250 | 0 | D |
| Stock Option (Right to Buy) | $13.50 | Mar 7, 2017 | M | 250 | D | Jan 24, 2010 | Jan 23, 2018 | Common | 250 | 0 | D |
| Stock Option (Right to Buy) | $13.50 | Mar 7, 2017 | M | 250 | D | Jan 24, 2011 | Jan 23, 2018 | Common | 250 | 0 | D |
Explanation of responses
- F1The number of shares in column 5 is the reporting person's best estimate based on a plan statement dated December 31, 2016.