SEC Form 4 · accession 0000905729-17-000160
CHOICEONE FINANCIAL SERVICES INC · COFS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Sheila R Clark
Officer — S.V.P. - ChoiceOne Bank (Sub.)
Period of report
Apr 15, 2017
Accepted (ET)
Apr 18, 2017 · 2:56 pm EDT
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 StockF1 | Apr 15, 2017 | A | 500 | $0.00 | A | 18,819 | D | |
| Common StockF2 | holding | — | — | — | 5,058 | 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) | $23.00 | Apr 15, 2017 | A | 375 | A | Apr 15, 2017 | Apr 14, 2027 | Common | 375 | 375 | D |
| Stock Option (Right to Buy) | $23.00 | Apr 15, 2017 | A | 375 | A | Apr 15, 2018 | Apr 14, 2027 | Common | 375 | 375 | D |
| Stock Option (Right to Buy) | $23.00 | Apr 15, 2017 | A | 375 | A | Apr 15, 2019 | Apr 14, 2027 | Common | 375 | 375 | D |
| Stock Option (Right to Buy) | $23.00 | Apr 15, 2017 | A | 375 | A | Apr 15, 2020 | Apr 14, 2027 | Common | 375 | 375 | D |
Explanation of responses
- F1Reports the grant of the contingent right to receive shares of common stock vesting in equal installments over a three-year vesting period.
- F2The number of shares in column 5 is the reporting person's best estimate based on a plan statement dated December 31, 2016.