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 |
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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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
BANCINSURANCE CORP [ BCIS ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 08/28/2008 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 | ||||||
Common Shares | 08/28/2008 | W | V | 309,076 | D | $0.00 | 353,592(1)(2) | I | Executor of the Estate of Si Sokol | |
Common Shares | 08/28/2008 | W | V | 309,076 | A | $0.00 | 309,076 | I | Trustee of the Marital Share of the Si Sokol Trust | |
Common Shares | 08/28/2008 | G | V | 309,076 | D | $0.00 | 0 | I | Trustee of the Marital Share of the Si Sokol Trust | |
Common Shares | 08/28/2008 | G | V | 309,076 | A | $0.00 | 309,076 | D | ||
Common Shares | 08/28/2008 | G | V | 7,050 | D | $0.00 | 302,026(2) | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 |
Explanation of Responses: |
1. 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. |
2. 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. |
Remarks: |
/s/ Barbara K. Sokol | 09/23/2008 | |
** 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. |