-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, HxCqQvgA8/2XIUOZxL2CjjIZi3HJog/BM2BCwfB3ohPy1BeVvm6AnlZY9mvTIsMe 3Y6yi7l5B/So5OBF5750oA== 0001209191-04-059164.txt : 20041222 0001209191-04-059164.hdr.sgml : 20041222 20041222164921 ACCESSION NUMBER: 0001209191-04-059164 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041215 FILED AS OF DATE: 20041222 DATE AS OF CHANGE: 20041222 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NORTH COUNTRY FINANCIAL CORP CENTRAL INDEX KEY: 0000036506 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 382062816 STATE OF INCORPORATION: MI FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3530 NORTH COUNTRY DR STREET 2: PO BOX 369 CITY: TRAVERSE CITY STATE: MI ZIP: 49684 BUSINESS PHONE: 9063418401 MAIL ADDRESS: STREET 1: 130 S CEDER ST STREET 2: P O BOX 369 CITY: MANISTIQUE STATE: MI ZIP: 49854 FORMER COMPANY: FORMER CONFORMED NAME: FIRST MANISTIQUE CORP DATE OF NAME CHANGE: 19920703 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tobias Paul Davison CENTRAL INDEX KEY: 0001312334 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-20167 FILM NUMBER: 041221362 BUSINESS ADDRESS: BUSINESS PHONE: 248-258-6900 MAIL ADDRESS: STREET 1: 1336 N. CRANBROOK CITY: BLOOMFIELD VILLAGE STATE: MI ZIP: 48301 3 1 bde90689_01pdt.xml MAIN DOCUMENT DESCRIPTION X0202 3 2004-12-15 0 0000036506 NORTH COUNTRY FINANCIAL CORP MFNC 0001312334 Tobias Paul Davison 38710 WOODWARD AVE. SUITE 240 BLOOMFIELD HILLS MI 48304 1 1 0 0 Chief Executive Officer Common Stock 41026 I By self through individual retirement account Common Stock 10256 I By Tobias Capital LLC Stock Option (right to buy) 2014-12-16 Common Stock 149970 D The reporting person, along with his wife and children, is a member of Tobias Capital LLC. Each of reporting person and his wife hold a 35% ownership interest in said company. 20% of the option became exercisable on 12/16/04. Of the remaining option, 27% of the original becomes exercisable when the closing price of the Common Stock equals 1.15 times the initial exercise price for a period of 10 consecutive trading days. Another 27% of the original option becomes exercisable when the closing price of the Common Stock equals 1.30 times the initial exercise price for a period of 10 consecutive trading days after 12/16/04. The remaining 26% of the original option becomes exercisable when the closing price of the Common Stock equals 1.45 times the initial exercise price for a period of 10 consecutive trading days after 12/16/04. 149,970 is an estimated number of options. Such number is subject to adjustment (upwards or downwards) based on the actual number of outstanding shares of the Compnay's Common Stock as a result of the Reverse Stock Split which took effect on December 15, 2004 (see the Company's Current Report on Form 8-K filed with the Securities and Exchange Commission on December 16, 2004 which describes the Reverse Stock Split and certian other transactions affecting the Company). The initial exercise price is $9.75. Paul Davison Tobias 2004-12-22 -----END PRIVACY-ENHANCED MESSAGE-----