-----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, RP3tqZi2Y6lW1J05RgjatjmOLMA59ydftk77t1/ufURSlA6rx1uWLDcP9VZogDPf MMjWnqjDGvstmfcycz9NJQ== 0001209191-04-056784.txt : 20041209 0001209191-04-056784.hdr.sgml : 20041209 20041209160658 ACCESSION NUMBER: 0001209191-04-056784 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20041111 FILED AS OF DATE: 20041209 DATE AS OF CHANGE: 20041209 ISSUER: 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 BUSINESS ADDRESS: STREET 1: 250 EAST BROAD STREET STREET 2: 10TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 BUSINESS PHONE: 6142282800 MAIL ADDRESS: STREET 1: 250 EAST BROAD STREET STREET 2: 10TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SOKOL SI CENTRAL INDEX KEY: 0000938330 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-08738 FILM NUMBER: 041193498 MAIL ADDRESS: STREET 1: 20 EAST BROAD STREET 4TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 FORMER NAME: FORMER CONFORMED NAME: SOKOL SI ET AL DATE OF NAME CHANGE: 19950807 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2004-11-11 0 0000276400 BANCINSURANCE CORP BCIS 0000938330 SOKOL SI 250 E. BROAD ST. 10TH FLOOR COLUMBUS OH 43215 1 1 1 0 Chairman and CEO Common Shares 2004-11-11 5 G 0 E 500 0.00 D 312992 I Spouse Common Shares 2004-11-12 5 G 0 E 2000 0.00 D 310992 I Spouse Simon Sokol also directly owns 318,976 BCIS common shares. Simon Sokol may also be deemed to indirectly own 1,750,000 BCIS common shares which are owned by Falcon Equity Partners, L.P. ("Falcon L.P."), an Ohio limited partnership whose partners are members of the Simon Sokol family. Simon Sokol holds a 35.7 percentage interest in Falcon L.P., and disclaims beneficial ownership of BCIS common shares held by Falcon L.P., except to the extent of his individual pecuniary interest therein. These 310,992 BCIS common shares are owned of record by Simon Sokol's wife, Barbara K. Sokol. Simon Sokol disclaims beneficial ownership of such BCIS common shares, and the filing of this report is not an admission that Simon Sokol is the benenfical owner of such BCIS common shares for purposes of Section 16 or for any other purpose. /s/Matt Nolan, As Attorney in Fact 2004-12-09 EX-24.4_64333 2 poa.txt POA DOCUMENT LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS Know all by these presents, that the undersigned's hereby makes, constitutes and appoints John S. Sokol and Mtthew C. Nolan as the undersigned's true and lawful attorney-in-fact, with full power and authority as hereinafter described on behalf of and in the name, place and stead of the undersigned to: (1) prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5 (including any amendments thereto) with respect to the securities of Bancinsurance Corporation, an Ohio corporation (the "Company"), with the United States Securities and Exchange Commission, any national securities exchanges and the Company, as considered necessary or advisable under Section 16(a) of the Securities Exchange Act of 1934 and the rules and regulations promulgated thereunder, as amended from time to time (the "Exchange Act"); (2) seek or obtain, as the undersigned's representative and on the undersigned's behalf, information on transactions in the Company's securities from any third party, including brokers, employee benefit plan administrators and trustees, and the undersigned hereby authorizes any such person to release any such information to the undersigned and approves and ratifies any such release of information; and (3) perform any and all other acts which in the discretion of such attorney-in-fact are necessary or desirable for and on behalf of the undersigned in connection with the foregoing. The undersigned acknowledges that: (1) this Power of Attorney authorizes, but does not require, such attorney-in-fact to act in their discretion on information provided to such attorney-in-fact without independent verification of such information; (2) any documents prepared and/or executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney will be in such form and will contain such information and disclosure as such attorney-in-fact, in his or her discretion, deems necessary or desirable; (3) neither the Company nor such attorney-in-fact assumes (i) any liability for the undersigned's responsibility to comply with the requirement of the Exchange Act, (ii) any liability of the undersigned for any failure to comply with such requirements, or (iii) any obligation or liability of the undersigned for profit disgorgement under Section 16(b) of the Exchange Act; and (4) this Power of Attorney does not relieve the undersigned from responsibility for compliance with the undersigned's obligations under the Exchange Act, including without limitation the reporting requirements under Section 16 of the Exchange Act. The undersigned hereby gives and grants the foregoing attorney-in-fact full power and authority to do and perform all and every act and thing whatsoever requisite, necessary or appropriate to be done in and about the foregoing matters as fully to all intents and purposes as the undersigned might or could do if present, hereby ratifying all that such attorney-in-fact of, for and on behalf of the undersigned, shall lawfully do or cause to be done by virtue of this Limited Power of Attorney. This Power of Attorney shall remain in full force and effect until revoked by the undersigned in a signed writing delivered to such attorney-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 2nd day of November, 2004. /s/Simon Sokol Signature Simon Sokol Print Name STATE OF COUNTY OF On this 2nd day of November, 2004, Simon Sokol personally appeared before me, and acknowledged that he executed the foregoing instrument for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Tina Hawley Notary Public My Commission Expires: 2-9-2005 -----END PRIVACY-ENHANCED MESSAGE-----