SEC Form 4 · accession 0000905729-18-000123
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
Jun 1, 2018
Accepted (ET)
Jun 5, 2018 · 3:20 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 | holding | — | — | — | 18,491 | D | ||
| Common stockF1 | holding | — | — | — | 2,644 | I | IRA | |
| Common stockF1 | holding | — | — | — | 541 | 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) | $25.65 | Jun 1, 2018 | A | 1,500 | A | Jun 1, 2018 | May 31, 2028 | Common | 1,500 | 1,500 | D |
| Stock Option (Right to Buy) | $25.65 | Jun 1, 2018 | A | 1,500 | A | Jun 1, 2019 | May 31, 2028 | Common | 1,500 | 1,500 | D |
| Stock Option (Right to Buy) | $25.65 | Jun 1, 2018 | A | 1,500 | A | Jun 1, 2020 | May 31, 2028 | Common | 1,500 | 1,500 | D |
| Stock Option (Right to Buy) | $25.65 | Jun 1, 2018 | A | 1,500 | A | Jun 1, 2021 | May 31, 2028 | Common | 1,500 | 1,500 | D |
Explanation of responses
- F1On April 25, 2018, ChoiceOne Financial Services, Inc. announced a 5% stock dividend, payable to all holders of record as of May 10, 2018. As a result, the reporting person received 1,029.8913 shares of common stock as of May 31, 2018, of which 879.1315 shares are owned directly, 125.0000 shares are owned indirectly through the reporting person's IRA and 25.7598 shares are owned indirectly through the reporting person's 401(k) plan.