Commission
File Number: 333-147456
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Michigan
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20-5393246
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(State
or other jurisdiction of incorporation or organization)
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(I.R.S.
Employer Identification Number)
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4471
Wilson Ave., SW, Grandville, Michigan 49418
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(616)
929-1600
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(Address
of principal executive offices) (ZIP Code)
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Registrant’s
telephone number, including area code)
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Item
12.
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Security
Ownership of Certain Beneficial Owners and Management and Related
Stockholder Matters
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3
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PART
IV
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Item
15.
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Exhibits,
Financial Statement Schedules
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5
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Signatures
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6
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ITEM
12.
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SECURITY
OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED
STOCKHOLDER MATTERS
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·
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the
number of shares of common stock he or she owns beneficially;
and
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·
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the
percentage that the number of shares beneficially owned bears to the total
number of shares outstanding of the
Company.
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Name
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Number
of shares beneficially owned
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Percentage
of class
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||||||
Directors
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Robert
P. Bilotti(1)
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48,874 | 2.85 | % | |||||
David
H. Blossey (2)
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5,000 | 0.29 | % | |||||
Richard
J. Blauw, Jr.(3)
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37,784 | 2.20 | % | |||||
Cheryl
M. Blouw(4)
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34,074 | 1.99 | % | |||||
Jeffrey
A. Elders(5)
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27,124 | 1.59 | % | |||||
Lawrence
B. Fitch(6)
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5,000 | 0.29 | % | |||||
David
K. Hovingh(7)
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36,597 | 2.14 | % | |||||
Roger
L. Roode(8)
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32,174 | 1.88 | % | |||||
Jerry
A. Sytsma(9)
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29,374 | 1.71 | % | |||||
Total
directors, as a group
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256,001 | 14.27 | % | |||||
Executive
officers who are not directors
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||||||||
Elizabeth
C. Bracken(10)
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1,500 | 0.09 | % | |||||
Mark
A. Martis(11)
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11,748 | 0.69 | % | |||||
All
directors and executive officers, as a group (11 persons)
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269,249 | 15.01 | % |
(1)
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Includes
organizer warrants to acquire 13,274 shares of common stock; 5,600 shares
held jointly with Mr. Bilotti’s wife; 4,000 shares held of record for the
benefit of Mr. Bilotti’s IRA; and 6,000 shares held of record for the
benefit of Mr. Bilotti’s Simple 401K
Plan.
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(2)
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Includes
5,000 shares held of record for the benefit of Mr. Blossey’s
IRA.
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(3)
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Includes
organizer warrants to acquire 14,509 shares of common stock (of which
1,235 warrants are held by Meadow Rock Dairy, L.L.C. and attributed to Mr.
Blauw through his 12.4% ownership interest in Meadow Rock Dairy, L.L.C.);
4,000 shares held jointly with Mr. Blauw’s wife; 12,000 shares held by the
Richard J Jr. and Kimberly S. Blauw Trust, which Mr. and Mrs. Blauw serve
as trustees; and 6,175 shares of common stock held by Meadow Rock Dairy,
L.L.C. and attributed to Mr. Blauw through his 12.4% ownership interest in
Meadow Rock Dairy, L.L.C.
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(4)
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Includes
organizer warrants to acquire 13,274 shares of common stock; 19,700 shares
held of record for the benefit of Mrs. Blouw’s IRAs; and 1,100 shares held
by the Ronald P and Cheryl M Blouw Living Trust, which Mr. and Mrs. Blouw
serve as trustees.
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(5)
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Includes
organizer warrants to acquire 13,274 shares of common stock; and 11,600
shares held of record for the benefit of Mr. Elders’
IRA.
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(6)
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Includes
5,000 shares held by the Lawrence B. Fitch Revocable Trust, which Mr.
Fitch serves as trustee.
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(7)
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Includes
organizer warrants to acquire 13,274 shares of common stock; 6,350 shares
held jointly with Mr. Hovingh’s wife; and 16,973 shares held of record for
the benefit of Mr. Hovingh’s IRA.
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(8)
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Includes
organizer warrants to acquire 13,274 shares of common stock; and 18,900
shares held by the Roger L. Roode Trust, which Mr. Roode serves as
trustee.
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(9)
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Includes
organizer warrants to acquire 13,274 shares of common stock; 15,220 held
by the Jerry and Lynn Sytsma Trust, which Mr. and Mrs. Sytsma serve as
trustees; and 880 shares held of record for the benefit of the IRA of Mr.
Sytsma’ wife.
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(10)
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Includes
500 shares held of record for the benefit of Ms. Bracken’s IRA; and 1,000
shares held of record for the benefit of the IRA of Ms. Bracken’s
husband.
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(11)
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Includes
9,992 shares held of record for the benefit of Mr. Martis’ IRA; and 1,756
shares held of record for the benefit of the IRA of Mr. Martis’
wife.
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Name
and Address of Principal Shareholder
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Number
of shares beneficially owned
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Percentage
of class
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||||||
Great
Midwest Investments, L.L.C.
50
64th
Avenue, Suite A
Coopersville,
Michigan 49404
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100,000 | 5.88 | % | |||||
Timothy
den Dulk(1)
50
64th
Avenue, Suite A
Coopersville,
Michigan 49404
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150,000 | 8.82 | % |
(1)
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Includes
100,000 shares of common stock held by Great Midwest Investments, L.L.C.
and attributed to Mr. Dulk through his 50% ownership interest in Great
Midwest Investments, L.L.C.; and 50,000 shares of common stock held by
Meadow Rock Dairy, L.L.C. and attributed to Mr. Dulk through his 53.1%
ownership interest in Meadow Rock Dairy,
L.L.C.
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ITEM
15.
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EXHIBITS,
FINANCIAL STATEMENT SCHEDULES
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Number
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Description
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1.1
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Agency
Agreement by and between the Company and Commerce Street Capital,
LLC*
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3.1
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Articles
of incorporation**
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3.2
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Bylaws**
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3.3
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Amended
and Restated Bylaws***
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4.1
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Specimen
common stock certificate**
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4.2
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Form
of Grand River Commerce, Inc. Organizers’ Warrant
Agreement**
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4.3
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See
Exhibits 3.1 and 3.2 for provisions of the articles of incorporation and
bylaws defining rights of holders of the common
stock****
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10.3
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Form
of Grand River Commerce, Inc. 2009 Stock Incentive
Plan+**
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10.4
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Employment
Agreement by and between Grand River Bank and David H.
Blossey+****
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10.5
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Employment
Agreement by and between Grand River Bank and Robert P.
Bilotti+****
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10.6
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Employment
Agreement by and between Grand River Bank and Elizabeth C.
Bracken+****
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10.7
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Consulting
Agreement by and between Grand River Commerce, Inc. and David H.
Blossey+**
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10.8
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Consulting
Agreement by and between Grand River Commerce, Inc. and Robert P.
Bilotti+**
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10.9
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Consulting
Agreement by and between Grand River Commerce, Inc. and Elizabeth C.
Bracken+**
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10.12
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Employment
Agreement by and between Grand River Bank and Mark
Martis+****
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10.13
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Consulting
Agreement by and between Grand River Commerce, Inc. and Mark
Martis+**
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31.1
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Certification
of Chief Executive Officer
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31.2
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Certification
of Chief Financial Officer
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32.1
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Certifications
pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of
the Sarbanes-Oxley Act of
2002
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+
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Indicates
a compensatory plan or contract
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*
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Incorporated
by reference to the exhibits to the Company’s Form 8-K as filed with the
SEC on March 10, 2009
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**
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Incorporated
by reference to the exhibits to the Company’s registration statement as
filed with the SEC on November 16,
2007
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***
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Incorporated
by reference to the exhibits to the Company’s Form 8-K as filed with the
SEC on May 30, 2008
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****
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Incorporated
by reference to the exhibits to the Company’s Form 10-K for the year ended
December 31, 2009 as filed with the SEC on March 18,
2010
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GRAND
RIVER COMMERCE, INC.
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By:
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/s/ Robert P. Bilotti | |
Robert P. Bilotti | |||
President and Chief Executive Officer | |||
Date: | November 16, 2010 |