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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 | ||||||||
ORGANIZER WARRANTS | $ 10 | 11/17/2010 | J(1) | 2,479 | 04/30/2009 | 04/30/2019 | COMMON STOCK | 13,274 | (2) | 10,795 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
ROODE ROGER LEE 4471 WILSON AVENUE SW GRANDVILLE, MI 49418 |
X |
/s/ Roger L. Roode | 11/17/2010 | |
**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) | In recognition of the substantial financial risks undertaken by the members of Grand River Commerce, Inc.'s organizing group, Grand River Commerce, Inc. granted warrants to purchase common stock to the organizers, including the warrants reported on the reporting person's Form 3, filed on May 4, 2010, and amended on November 16, 2010. Additionally, in recognition of the substantial financial risks undertaken by certain investors of Grand River Commerce, Inc., Grand River Commerce, Inc. and the organizers agreed to transfer a certain amount of organizer warrants to the investors, including the transfer of warrants described herein. |
(2) | The reporting person did not receive any consideration for the transaction described herein. |