Sec Form 4 Filing - FRONCZEK JODI @ DCP Holding CO - 2019-06-27

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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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1. Name and Address of Reporting Person
FRONCZEK JODI
2. Issuer Name and Ticker or Trading Symbol
DCP Holding CO [ NONE]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Vice President & COO
(Last) (First) (Middle)
100 CROWNE POINT PLACE
3. Date of Earliest Transaction (MM/DD/YY)
06/27/2019
(Street)
SHARONVILLE, OH45241
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Restricted Share Units (vested) ( 1 ) ( 2 ) 06/27/2019 D 107.83 ( 3 ) ( 3 ) Class B Common Shares 107.83 ( 3 ) 0 D
Restricted Share Units (unvested) ( 1 ) ( 2 ) 06/27/2019 D 8.8 ( 4 ) ( 4 ) Class B Common Shares 8.8 ( 4 ) 0 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
FRONCZEK JODI
100 CROWNE POINT PLACE
SHARONVILLE, OH45241
Vice President & COO
Signatures
/s/ Robert C. Hodgkins, Jr., as attorney-in-fact for Jodi Fronczek 06/27/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Disposed of pursuant to the Merger Agreement between Issuer and DentaQuest LLC. In the Merger, Issuer shareholders received $2,527.46 per common share ("Merger Consideration"), exclusive of a special dividend of $462.36 ("Special Dividend") per common share paid by the Issuer.
( 2 )Each Restricted Share Unit is the economic equivalent of one Class B Common Share of Issuer.
( 3 )Vested Restricted Share Units were granted to the Reporting Person pursuant to the Issuer's 2006 Dental Care Plus Management Equity Incentive Plan. The Reporting Person elected to defer the receipt of the Restricted Share Units under the Issuer's Deferred Compensation Plan, and therefore, the Vested Restricted Share Units were settled for the Merger Consideration and the Special Dividend in cash upon the consummation of the Merger.
( 4 )Unvested Restricted Share Units vested upon consummation of the Merger and were converted into a right to receive the Merger Consideration and the Special Dividend.

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