0000899243-18-000569.txt : 20180105 0000899243-18-000569.hdr.sgml : 20180105 20180105140508 ACCESSION NUMBER: 0000899243-18-000569 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171229 FILED AS OF DATE: 20180105 DATE AS OF CHANGE: 20180105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rosen Steven CENTRAL INDEX KEY: 0001545202 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-00147 FILM NUMBER: 18512986 MAIL ADDRESS: STREET 1: 25101 CHAGRIN BOULEVARD SUITE 350 CITY: BEACHWOOD STATE: OH ZIP: 44122 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HICKOK INC CENTRAL INDEX KEY: 0000047307 STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823] IRS NUMBER: 340288470 STATE OF INCORPORATION: OH FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 10514 DUPONT AVE CITY: CLEVELAND STATE: OH ZIP: 44108 BUSINESS PHONE: 2165418060 MAIL ADDRESS: STREET 1: 10514 DUPONT AVE CITY: CLEVELAND STATE: OH ZIP: 44108 FORMER COMPANY: FORMER CONFORMED NAME: HICKOK ELECTRICAL INSTRUMENT CO DATE OF NAME CHANGE: 19920703 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-12-29 0 0000047307 HICKOK INC HICKA 0001545202 Rosen Steven 25101 CHAGRIN BOULEVARD, SUITE 350 BEACHWOOD OH 44122 1 0 1 0 Class A Common Stock 320918 I See Footnote Class A Common Stock 3000 D Warrant to Purchase Class A Common Stock 2.50 2016-12-20 4 D 0 100000 D 2017-12-30 Class A Common Stock 100000 252367 I See Footnote Warrant to Purchase Class A Common Stock 2.50 2016-12-20 4 A 0 100000 A 2018-12-30 Class A Common Stock 100000 426489 I See Footnote Convertible Loan Agreement 1.85 2016-12-20 4 D 0 252367 D 2017-12-30 Class A Common Stock 252367 100000 I See Footnote Convertible Loan Agreement 1.85 2016-12-20 4 A 0 326489 A 2018-12-30 Class A Common Stock 326489 426489 I See Footnote Class A Common Stock Option 2.925 2012-03-08 2022-03-08 Class A Common Stock 1000 1000 D The two reported transactions involved an amendment of an outstanding warrant, resulting in the deemed cancellation of the "old" warrant and the grant of a replacement warrant. The two reported transactions involved an amendment of an outstanding convertible loan agreement, resulting in the deemed cancellation of the "old" convertible loan agreement and the entry into a replacement convertible loan agreement. The securities reported herein are owned directly by Roundball, LLC, an Ohio limited liability company. For purposes of the Securities Exchange Act of 1934, the Reporting Person disclaims beneficial ownership of any securities, except of his pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or otherwise. /s/ Fred Widen, Attorney-in-fact 2018-01-05