Statement of Changes in Beneficial Ownership (4)
June 18 2020 - 2:55PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
POTES KELLY |
2. Issuer Name and Ticker or Trading Symbol
CHOICEONE FINANCIAL SERVICES INC
[
COFS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chief Executive Officer |
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(Last)
(First)
(Middle)
109 EAST DIVISION STREET |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/16/2020 |
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(Street)
SPARTA, MI 49345
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common stock | 6/16/2020 | | M | | 8820 | A | $21.13 | 32079.6561 (1) | D | |
| Common stock | 6/16/2020 | | F | | 6892 | D | $30.45 | 25187.6561 | D | |
| Common stock | 6/16/2020 | | M | | 6615 | A | $20.86 | 31802.6561 | D | |
| Common stock | 6/16/2020 | | F | | 5127 | D | $30.45 | 26675.6561 | D | |
| Common stock | | | | | | | | 2643.8979 | I | IRA |
| Common stock | | | | | | | | 540.9548 | I | 401(k) Plan |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code
(Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4) | 8. Price of Derivative Security
(Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Stock Option (Right to Buy) | $21.13 | 6/16/2020 | | M | | | 2205 | 12/16/2015 | 12/16/2025 | Common | 2205 | $0 | 0 | D | |
| Stock Option (Right to Buy) | $21.13 | 6/16/2020 | | M | | | 2205 | 12/16/2016 | 12/16/2025 | Common | 2205 | $0 | 0 | D | |
| Stock Option (Right to Buy) | $21.13 | 6/16/2020 | | M | | | 2205 | 12/16/2017 | 12/16/2025 | Common | 2205 | $0 | 0 | D | |
| Stock Option (Right to Buy) | $21.13 | 6/16/2020 | | M | | | 2205 | 12/16/2018 | 12/16/2025 | Common | 2205 | $0 | 0 | D | |
| Stock Option (Right to Buy) | $20.86 | 6/16/2020 | | M | | | 1653 | 4/15/2017 | 4/15/2027 | Common | 1653 | $0 | 0 | D | |
| Stock Option (Right to Buy) | $20.86 | 6/16/2020 | | M | | | 1654 | 4/15/2018 | 4/15/2027 | Common | 1654 | $0 | 0 | D | |
| Stock Option (Right to Buy) | $20.86 | 6/16/2020 | | M | | | 1654 | 4/15/2019 | 4/15/2027 | Common | 1654 | $0 | 0 | D | |
| Stock Option (Right to Buy) | $20.86 | 6/16/2020 | | M | | | 1654 | 10/1/2019 | 4/15/2027 | Common | 1654 | $0 | 0 | D | |
| Explanation of Responses: |
| (1) | Column 5 includes 58 shares erroneously reported as withheld for tax purposes on the reporting person's previously filed Form 4. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
POTES KELLY
109 EAST DIVISION STREET
SPARTA, MI 49345 | X |
| Chief Executive Officer |
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Signatures
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| /s/ Thomas L. Lampen, by Power of Attorney | | 6/18/2020 |
| **Signature of Reporting Person | Date |
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