Sec Form 4 Filing - Rosen Steven @ HICKOK INC - 2017-12-29

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
Rosen Steven
2. Issuer Name and Ticker or Trading Symbol
HICKOK INC [ HICKA]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
25101 CHAGRIN BOULEVARD, SUITE 350
3. Date of Earliest Transaction (MM/DD/YY)
12/29/2017
(Street)
BEACHWOOD, OH44122
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
Class A Common Stock 320,918 I See Footnote ( 3 )
Class A Common Stock 3,000 D
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
Warrant to Purchase Class A Common Stock $ 2.5 12/20/2016 D( 1 ) 100,000 ( 1 ) 12/30/2017 Class A Common Stock 100,000 ( 1 ) 252,367 I See Footnote ( 3 )
Warrant to Purchase Class A Common Stock $ 2.5 12/20/2016 A( 1 ) 100,000 ( 1 ) 12/30/2018 Class A Common Stock 100,000 ( 1 ) 426,489 I See Footnote ( 3 )
Convertible Loan Agreement $ 1.85 12/20/2016 D( 2 ) 252,367 ( 2 ) 12/30/2017 Class A Common Stock 252,367 ( 2 ) 100,000 I See Footnote ( 3 )
Convertible Loan Agreement $ 1.85 12/20/2016 A( 2 ) 326,489 ( 2 ) 12/30/2018 Class A Common Stock 326,489 ( 2 ) 426,489 I See Footnote ( 3 )
Class A Common Stock Option $ 2.925 03/08/2012 03/08/2022 Class A Common Stock 1,000 1,000 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Rosen Steven
25101 CHAGRIN BOULEVARD, SUITE 350
BEACHWOOD, OH44122
X X
Signatures
/s/ Fred Widen, Attorney-in-fact 01/05/2018
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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.
( 2 )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.
( 3 )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.

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).

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