Statement of Changes in Beneficial Ownership (4)
April 05 2022 - 7:51PM
Edgar (US Regulatory)
FORM 4
[X]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
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
*
Scurlock Eva A. |
2. Issuer Name and Ticker or Trading Symbol
Level One Bancorp Inc
[
LEVL
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) EVP, Risk Management Officer |
(Last)
(First)
(Middle)
32991 HAMILTON COURT |
3. Date of Earliest Transaction
(MM/DD/YYYY)
4/1/2022 |
(Street)
FARMINGTON HILLS, MI 48334
(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 | 4/1/2022 | | D | | 14312 | D | (1) | 0 | D | |
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 |
Option (Right to Buy) | $10.82 | 4/1/2022 | | D | | | 3000 | (2) | 5/16/2023 | Common Stock | 3000.0 | (3) | 0 | D | |
Option (Right to Buy) | $13.5 | 4/1/2022 | | D | | | 6500 | (4) | 7/17/2024 | Common Stock | 6500.0 | (3) | 0 | D | |
Option (Right to Buy) | $17.15 | 4/1/2022 | | D | | | 6500 | (5) | 7/16/2025 | Common Stock | 6500.0 | (3) | 0 | D | |
Option (Right to Buy) | $20.75 | 4/1/2022 | | D | | | 7000 | (6) | 2/18/2026 | Common Stock | 7000.0 | (3) | 0 | D | |
Option (Right to Buy) | $24.8 | 4/1/2022 | | D | | | 5000 | (7) | 2/15/2028 | Common Stock | 5000.0 | (3) | 0 | D | |
Explanation of Responses: |
(1) | Pursuant to the Agreement and Plan of Merger, dated November 4, 2021 (the "Merger Agreement"), between First Merchants Corporation ("First Merchants") and Level One Bancorp, Inc. ("Level One"), each share of Level One common stock held by the reporting person was converted into the right to receive 0.7167 shares of First Merchants common stock and $10.17 in cash. |
(2) | These options vest in three equal annual installments beginning one year after the 5/16/2013 date of grant. |
(3) | Pursuant to the Merger Agreement, this option was converted into an option with respect to a number of shares of First Merchants common stock equal to the number of shares subject to such stock option, multiplied by the Option Conversion Ratio (as defined in the Merger Agreement). |
(4) | These options vest in three equal annual installments beginning one year after the 7/17/2014 date of grant. |
(5) | These options vest in three equal annual installments beginning one year after the 7/16/2015 date of grant. |
(6) | These options vest in three equal annual installments beginning one year after the 2/18/2016 date of grant. |
(7) | These options vest in three equal annual installments beginning one year after the 2/15/2018 date of grant. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Scurlock Eva A. 32991 HAMILTON COURT FARMINGTON HILLS, MI 48334 |
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| EVP, Risk Management Officer |
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Signatures
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/s/ David C. Walker, attorney-in-fact | | 4/5/2022 |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* | 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). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
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. |
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