-----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, H5d53W7i7Y5z/fMmwKsfueO09hjXPyRByp4UYdbAIOO3owhpRX1HoOGcKgpvtyfs uIjzf8dh/WZmyD0CmkdcxQ== 0000950152-96-001401.txt : 19960409 0000950152-96-001401.hdr.sgml : 19960409 ACCESSION NUMBER: 0000950152-96-001401 CONFORMED SUBMISSION TYPE: 3/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960408 SROS: NONE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BANCINSURANCE CORP CENTRAL INDEX KEY: 0000276400 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 310790882 STATE OF INCORPORATION: OH FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-08738 FILM NUMBER: 96545185 BUSINESS ADDRESS: STREET 1: 20 E BROAD ST STREET 2: 4TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 BUSINESS PHONE: 6142282800 MAIL ADDRESS: STREET 1: 20 E. BROAD STREET STREET 2: 4TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 COMPANY DATA: COMPANY CONFORMED NAME: HARKINS DANIEL DRURY CENTRAL INDEX KEY: 0001011623 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3/A BUSINESS ADDRESS: STREET 1: 4369 DONINGTON ROAD CITY: COLUMBUS STATE: OH ZIP: 43220 BUSINESS PHONE: 6142282800 MAIL ADDRESS: STREET 1: 4369 DONINGTON ROAD CITY: COLUMBUS STATE: OH ZIP: 43220 3/A 1 BANCINSURANCE CORPORATION FORM 3/A 1
------------------------ FORM 4 OMB Approval U.S. SECURITIES AND EXCHANGE COMMISSION ------------------------- [ ] Check this box if no longer WASHINGTON, D.C. 20549 OMB Number 3235-0287 subject to Section 16. Form Expires: February 1, 1994 4 or Form 5 obligations may STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden continue. See Instruction 1(b). hours per response...0.5 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(f) of the Investment Company Act of 1940 - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person| 2. Issuer Name and Ticker or Trading Symbol | 6. Relationship of Reporting Person | BANCINSURANCE CORPORATION (BCIS) | to Issuer (Check all applicable) HARKINS DANIEL DRURY | | __X__ Director _____ 10% Owner - -------------------------------------------------------------------------------------------| _____ Officer (give title below) (Last) (First) (Middle) | 3. IRS or Social | 4. Statement for | _____ Other (specify below) | Security Number | Month/Year | 4369 DONINGTON ROAD | of Reporting | MARCH 1996 | - ---------------------------------------| Person (Voluntary) |-------------------------| (Street) | | 5. If Amendment, | ________________________________ | | Date of Original | | | (Month/Year) | COLUMBUS OHIO 43220 | ###-##-#### | 4-8-96 | - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) | Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security | 2.Transaction | 3.Transaction | 4.Securities Acquired(A) | 5.Amount of | 6.Owner-| 7.Nature (Instr. 3) | Date | Code | or Disposed of (D) | Securities | ship | of | (Month/Day/ | (Instr. 8) | (Instr. 3, 4, and 5) | Beneficially| Form: | Indirect | Year) | | | Owned at End| Direct | Bene- | | --------------|--------------------------| of Month | (D) or | ficial | | | | Amount | (A) | Price | (Instr. 3 | Indirect| Owner- | | Code | V | | or | | and 4) | (I) | ship | | | | | (D) | | |(Instr.4)|(Instr.4) - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- COMMON STOCK | 3-28-96 | S | | 8,500 | D | 3.125* | 46,500 | D | - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- | | | | | | | | | - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- | | | | | | | | | - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- | | | | | | | | | - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- | | | | | | | | | - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- | | | | | | | | | - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- * Price determined in negotiation | | | | | | | | | - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- between Daniel Harkins and | | | | | | | | | - ---------------------------------------|---------------|-------|-------|--------|------|----------|-------------|---------|--------- Bancinsurance Corporation (PRIVATE SALE) | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
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FORM 4 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1.Title of Derivative Security | 2.Conversion | 3.Transaction | 4.Transaction | 5.Number of | 6.Date Exer- | 7.Title and Amount (Instr. 3) | or Exercise | Date | Code | Derivative | cisable and | of Underlying | Price of | | (Instr. 8) | Securities | Expiration Date | Securities | Derivative | (Month/Day/ | | Acquired (A) | (Month/Day/Year) | (Instr. 3 and 4) | Security | Year) | | or Disposed | | | | | | of (D) |-------------------------------------- | | | | (Instr. 3, | Date | Expir- | | Amount or | | | | 4, and 5) | Exer- | ation | Title | Number of | | |---------------|--------------| cisable | Date | | Shares | | | Code | V | (A) | (D) | | | | - ------------------------------------------------------------------------------------------------------------------------------------ | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - -------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|---------- | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ 8.Price of | 9.Number of | 10.Ownership | 11.Nature of | Derivative | Derivative | Form of | Indirect | Security | Securities | Derivative | Beneficial | (Instr. 5) | Beneficially | Security; | Ownership | | Owned at End | Direct (D) or | (Instr. 4) | | of Month | Indirect (I) | | | (Instr. 4) | (Instr. 4) | | - -------------------------------------------------------------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - --------------|----------------|-------------------|---------------| | | | | - ------------------------------------------------------------------- Explanation of Responses: /s/ Daniel D. Harkins /s/ Illegible 4/1/96 ------------------------------------ ----------------- *Signature of Reporting Person Date ** 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 provided is insufficient, see Instruction 6 for procedure. Page 2 SEC 1474 (3/91)
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