0001140361-16-083364.txt : 20161024 0001140361-16-083364.hdr.sgml : 20161024 20161024153226 ACCESSION NUMBER: 0001140361-16-083364 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161021 FILED AS OF DATE: 20161024 DATE AS OF CHANGE: 20161024 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: LAKE SHORE BANCORP, INC. CENTRAL INDEX KEY: 0001341318 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 204729288 FISCAL YEAR END: 1216 BUSINESS ADDRESS: STREET 1: 31 EAST FOURTH STREET CITY: DUNKIRK STATE: NY ZIP: 14048 BUSINESS PHONE: 716-366-4070 MAIL ADDRESS: STREET 1: 31 EAST FOURTH STREET CITY: DUNKIRK STATE: NY ZIP: 14048 FORMER COMPANY: FORMER CONFORMED NAME: Lake Shore Bancorp, Inc. DATE OF NAME CHANGE: 20051012 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ballard Susan C. CENTRAL INDEX KEY: 0001538814 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51821 FILM NUMBER: 161948095 MAIL ADDRESS: STREET 1: 128 EAST FOURTH STREET CITY: DUNKIRK STATE: NY ZIP: 14048 4 1 doc1.xml FORM 4 X0306 4 2016-10-21 0 0001341318 LAKE SHORE BANCORP, INC. LSBK 0001538814 Ballard Susan C. C/O 31 EAST FOURTH STREET DUNKIRK NY 14048 1 0 0 0 Common Stock 6279 D Stock Options (Right to Buy) 14.38 2016-10-21 4 A 0 8220 0.00 A 2016-10-21 Common Stock 8220 8220 D Includes 2,321 shares of restricted stock which will vest in three equal annual installments. The first installment will vest on August 12, 2017. Includes 640 shares of restricted stock which vest on December 16, 2016. Stock options vest at a rate of 20% per year commencing on October 21, 2017. /s/ Rachel A. Foley, pursuant to power of attorney 2016-10-24