-----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, EIPQKdC3U1k1E91cFTzXLQL0jzolfvrNpzvv2SSu44ODl8ZTs+sW0IbCnP5mn3y+ Y+FP8pmglvrGrts7AtcVzw== 0001209191-08-053041.txt : 20080923 0001209191-08-053041.hdr.sgml : 20080923 20080923105527 ACCESSION NUMBER: 0001209191-08-053041 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20080828 FILED AS OF DATE: 20080923 DATE AS OF CHANGE: 20080923 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 BARBARA K CENTRAL INDEX KEY: 0000949066 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-08738 FILM NUMBER: 081083748 BUSINESS ADDRESS: STREET 1: 20 EAST STREET 2: 20 EAST BROAD STREET 4TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 BUSINESS PHONE: 6142282800 MAIL ADDRESS: STREET 1: 20 EAST BROAD STREET 4TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 4 1 doc4.xml FORM 4 SUBMISSION X0303 4 2008-08-28 0 0000276400 BANCINSURANCE CORP BCIS 0000949066 SOKOL BARBARA K 250 E. BROAD ST. 10TH FLOOR COLUMBUS OH 43215 0 0 1 0 Common Shares 2008-08-28 5 W 0 E 309076 0.00 D 353592 I Executor of the Estate of Si Sokol Common Shares 2008-08-28 5 W 0 E 309076 0.00 A 309076 I Trustee of the Marital Share of the Si Sokol Trust Common Shares 2008-08-28 5 G 0 E 309076 0.00 D 0 I Trustee of the Marital Share of the Si Sokol Trust Common Shares 2008-08-28 5 G 0 E 309076 0.00 A 309076 D Common Shares 2008-08-28 5 G 0 E 7050 0.00 D 302026 D The reporting person is the surviving spouse of Si Sokol and the sole executor of the Estate of Si Sokol. The reporting person previously reported indirect beneficial ownership of the 612,668 BCIS common shares which were owned by the late Si Sokol at the time of his death on July 3, 2007. On September 28, 2007, the Estate of Si Sokol acquired an additional 50,000 BCIS common shares through the exercise of an outstanding option to purchase 50,000 BCIS common shares (at an exercise price of $4.75 per share acquired) that was held by Si Sokol on the date of his death. The reporting person may also be deemed to indirectly beneficially 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 Si Sokol family and the Estate of Si Sokol. The reporting person holds a 34.9 percentage interest in Falcon L.P. in her individual capacity and the Estate of Si Sokol holds a 34.6 percentage interest in Falcon L.P. The reporting person disclaims beneficial ownership of the BCIS common shares held by Falcon L.P., except to her pecuniary interest therein. /s/ Barbara K. Sokol 2008-09-23 -----END PRIVACY-ENHANCED MESSAGE-----