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) 10/17/2008 | ||||||||||||||||||||||||||
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 | 10/17/2008 | G | V | 603,963.67(1)(2) | D | $0.00 | 1,750,000(1)(2) | I | By Limited Partnership(1)(2) | |
Common Shares | 01/01/2009 | W | V | 603,963.67(1)(2) | D | $0.00 | 1,750,000(1)(2) | I | By Limited Partnership(1)(2) | |
Common Shares | 01/01/2009 | W | V | 411,132.33(1)(2) | A | $0.00 | 1,750,000(1)(2) | I | By Limited Partnership(1)(2) | |
Common Shares | 01/01/2009 | W | V | 192,831.34(1)(2) | A | $0.00 | 1,750,000(1)(2) | I | By Limited Partnership(1)(2) | |
Common Shares | 01/01/2009 | G | V | 411,132.33(1)(2) | D | $0.00 | 1,750,000(1)(2) | I | By Limited Partnership(1)(2) | |
Common Shares | 01/01/2009 | G | V | 411,132.33(1)(2) | A | $0.00 | 1,750,000(1)(2) | I | By Limited Partnership(1)(2) | |
Common Shares | 01/01/2009 | W | V | 353,592 | D | $0.00 | 0 | I | Executor of the Estate of Si Sokol | |
Common Shares | 01/01/2009 | W | V | 180,796 | A | $0.00 | 180,796 | I | Trustee of the Family Share of the Si Sokol Trust | |
Common Shares | 01/01/2009 | W | V | 172,796 | A | $0.00 | 172,796 | I | Trustee of the Marital Share of the Si Sokol Trust | |
Common Shares | 01/01/2009 | G | V | 172,796 | D | $0.00 | 0 | I | Trustee of the Marital Share of the Si Sokol Trust | |
Common Shares | 01/01/2009 | G | V | 172,796 | A | $0.00 | 474,822 | D | ||
Common Shares | 01/16/2009 | G | V | 8,550 | D | $0.00 | 466,272 | 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 reported securities are owned by Falcon Equity Partners, L.P. ("Falcon"), an Ohio limited partnership whose partners are members of the Si Sokol family, including the reporting person, and trusts for the benefit of members of the Si Sokol family. |
2. Following the transactions reported herein, the reporting person holds, directly and indirectly as trustee of a trust for her benefit, a 34.8% interest in Falcon. On (a) October 17, 2008, the reporting person made gifts in the aggregate of a 34.5% interest in Falcon that was held directly by the reporting person and (b) January 1, 2009, (1) the reporting person, in her capacity as Executor of the Estate of Si Sokol, distributed in the aggregate a 34.5% interest in Falcon that was held by the Estate of Si Sokol to two trusts of which the reporting person is the sole trustee and beneficiary and, (2) following such distribution, the reporting person, in her capacity as trustee of one of such trusts, distributed a 23.5% interest in Falcon that was held by such trust to the reporting person. The reporting person disclaims beneficial ownership of the BCIS common shares held by Falcon, except to the extent of her pecuniary interest therein. |
Remarks: |
/s/ Barbara K. Sokol | 02/13/2009 | |
** 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. |