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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Hagerman Philip R 4100 S. SAGINAW STREET FLINT, MI 48507 |
X | X | Chairman and CEO | |
Philip R. Hagerman Revocable Trust 4100 S. SAGINAW STREET FLINT, MI 48507 |
X | |||
JH GST Trust 4100 S. SAGINAW STREET FLINT, MI 48507 |
X | |||
2007 Hagerman Family GST Trust 4100 S. SAGINAW STREET FLINT, MI 48507 |
X | |||
Hagerman Jocelyn 4100 S. SAGINAW STREET FLINT, MI 48507 |
X |
Jeffrey H. Kuras, by Power of Attorney for Philip Hagerman | 01/15/2015 | |
**Signature of Reporting Person | Date | |
Jeffrey H. Kuras, by Power of Attorney for Philip R. Hagerman Rev Trust | 01/15/2015 | |
**Signature of Reporting Person | Date | |
Jeffrey H. Kuras, by Power of Attorney for 2007 Hagerman Family GST Trust | 01/15/2015 | |
**Signature of Reporting Person | Date | |
Jeffrey H. Kuras, by Power of Attorney for The JH GST Trust | 01/15/2015 | |
**Signature of Reporting Person | Date | |
Jeffrey H. Kuras, by Power of Attorney, for Jocelyn Hagerman | 01/15/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | These shares were sold as part of the initial public offering of the issuer's common stock. This amendment reflects the additional shares sold in the initial public offering pursuant to the underwriters' exercise of an option to purchase such shares in connection with such offering; the additional sale of shares was inadvertently omitted from the initial filing. |
(2) | These shares are owned directly by the Philip R. Hagerman Revocable Trust, a ten percent owner of the issuer, and indirectly by Philip Hagerman as trustee of the trust. Mr. Hagerman is Chairman, CEO and a director of the issuer. |
(3) | These shares are owned directly by the 2007 Hagerman Family GST Trust, a ten percent owner of the issuer, and indirectly by Jocelyn Hagerman as trustee of the trust. Mrs. Hagerman is the wife of Philip Hagerman. |
(4) | These shares are owned directly by the JH GST Trust, a ten percent owner of the issuer, and indirectly by Philip R. Hagerman as trustee of the trust. |
(5) | As trustee of the 2013 Irrevocable Exempt Trusts and 2014 Irrevocable Exempt Trusts for a son and daughter, the Philip Hagerman 2014 GRAT and the PH Marital Trust, Jocelyn Hagerman indirectly owns these shares. |
(6) | These shares are indirectly owned by Mr. Hagerman, who serves as the trustee of the 2013 Irrevocable Exempt Trusts and 2014 Irrevocable Exempt Trusts for two daughters, the Jocelyn Hagerman 2014 GRAT and the JH Marital Trust. |