-----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, WBZgpJSSE/7kwVhLXwvfmfU2lEAz0fzJ2l5dmAFshlcrSKnCilp+F8s5zcQD6hhp NV63jXFODgwBUDCqpvA1TQ== 0001209191-10-059304.txt : 20101209 0001209191-10-059304.hdr.sgml : 20101209 20101209132121 ACCESSION NUMBER: 0001209191-10-059304 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20101208 FILED AS OF DATE: 20101209 DATE AS OF CHANGE: 20101209 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: 7TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 BUSINESS PHONE: 614-220-5200 MAIL ADDRESS: STREET 1: 250 EAST BROAD STREET STREET 2: 7TH 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: 101241822 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 2010-12-08 1 0000276400 BANCINSURANCE CORP BCIS 0000949066 SOKOL BARBARA K 250 E. BROAD ST. 7TH FLOOR COLUMBUS OH 43215 0 0 1 0 Common Shares 450372 I By Fenist, LLC Common Shares 2010-12-09 4 J 0 450372 D 0 I By Fenist, LLC In connection with the merger of Fenist Acquistion Sub, Inc. ("Merger Sub") with and into the Issuer (the "Merger"), the Reporting Person contributed these shares of the Issuer's common stock to Fenist, LLC ("Parent") in exchange for equity interests in Parent. This contribution did not alter the Reporting Person's ultimate pecuniary interest in the common stock of the Issuer. In connection with the Merger, 180,796 shares of the Issuer's common stock which the Reporting Person beneficially owned as trustee and beneficiary of the Family Trust of the Si Sokol Trust were contributed to Parent in exchange for equity interests in Parent. This contribution did not alter the Reporting Person's ultimate pecuniary interest in the common stock of the Issuer. In connection with the Merger, Falcon Equity Partners, L.P. ("Falcon") contributed 1,750,000 shares of the Issuer's common stock to Parent in exchange for equity interests in Parent. The Reporting Person holds, directly and indirectly as trustee of trusts for the benefit of the Si Sokol family, an approximate 11% economic interest in Falcon. The Reporting Person disclaims beneficial ownership of the shares held by Falcon except to the extent of the Reporting Person's pecuniary interest therein. In connection with the Merger, all shares of the Issuer's common stock held by Parent were cancelled and ceased to exist. Barbara K. Sokol /s/ Matthew C. Nolan, as Attorney-in-Fact 2010-12-09 -----END PRIVACY-ENHANCED MESSAGE-----