SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
McCall Stephen Phillip

(Last) (First) (Middle)
199 WATER STREET, 20TH FLOOR

(Street)
NEW YORK NY 10038

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
OTELCO INC. [ OTT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/21/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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 12/21/2004 C 8,026,442 A (1) 8,026,442 I See Footnote(2)
Class A Common Stock(3) 12/21/2004 S 7,402,170 D $14.288(4) 624,272 I See Footnote(2)
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 (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 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 (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (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: 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
Membership Units (5) 12/21/2004 C 2,323,825.73 (6) (6) Income Deposit Securities 7,263,634 (5) 0(6) I See Footnote(2)
Membership Units (5) 12/21/2004 C 2,323,825.73(7) (6) (6) Class B Common Stock 453,105 (5) 0(6) I See Footnote(2)
Membership Units of Mid-Missouri Parent, LLC (8) 12/21/2004 J(9) 9,000 (9) (9) Income Deposit Securities 762,808 (8) 0(6) I See Footnote(2)
Membership Units of Mid-Missouri Parent, LLC (8) 12/21/2004 J(9) 9,000(10) (9) (9) Class B Common Stock 47,584 (8) 0(6) I See Footnote(2)
Class B Common Stock (11) 12/21/2004 C 500,689 (11) (12) Income Deposit Securities 500,689 (13) 500,689 I See Footnote(2)
Class B Common Stock (11) 12/21/2004 S 119,950 (11) (12) Income Deposit Securities 119,950 (13) 380,739 I See Footnote(2)
Explanation of Responses:
1. The reported securities are included within 8,026,442 Income Deposit Securities ("IDSs"). Each IDS consists of one share of Class A common stock and one 13% subordinated note due 2019 with a $7.50 principal amount.
2. See Exhibit 99.1.
3. Included in the sale of 7,402,170 IDSs that each consisted of one share of Class A common stock and one 13% senior subordinated note due 2019 with a $7.50 principal amount.
4. This is the sale price of the IDSs set forth in the Underwriting Agreement dated December 16, 2004, relating to the sale of the IDSs.
5. Conversion ratio of 3.12572 IDSs and 0.19498 shares of Class B common stock per membership unit.
6. The membership units converted into IDSs and Class B common stock on December 21, 2004, the closing date of the offering of IDSs.
7. These represent the same 2,323,825.73 membership units disposed of as shown in the line above.
8. Exchange ratio of 84.75644 IDSs and 5.28711 shares of Class B common stock per membership unit of Mid-Missouri Parent, LLC.
9. Membership units of Mid-Missouri Parent, LLC were exchanged for IDSs and shares of Class B common stock on December 21, 2004, the closing date of the offering of the IDSs, pursuant to a merger agreement, dated December 16, 2004.
10. These represent the same 9,000 membership units of Mid-Missouri Parent, LLC disposed of as shown in the line above.
11. The Class B common stock will be exchangable for IDSs beginning on December 21, 2006, subject to the satisfaction of certain conditions, including a financial test set forth in an investor rights agreement.
12. None.
13. The Class B common stock will be exchangable for IDSs on a 1 for 1 basis, subject to adjustment.
/s/ Michael D. Weaver, Attorney-in-Fact 12/21/2004
** Signature of Reporting Person Date
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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.