-----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, PvTqqDN/Mc5xRg1bdvaN4mxzKXgYZ2WB0DdiHJ0JZH5Qz3E/YwAD1nOmsGnnU+1K jfkKnqBaBkqDxl0C3TCLmQ== 0000887919-01-000002.txt : 20010205 0000887919-01-000002.hdr.sgml : 20010205 ACCESSION NUMBER: 0000887919-01-000002 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010131 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PREMIER FINANCIAL BANCORP INC CENTRAL INDEX KEY: 0000887919 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 611206757 STATE OF INCORPORATION: KY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-20908 FILM NUMBER: 1519653 BUSINESS ADDRESS: STREET 1: 115 N HAMILTON ST STREET 2: P O BOX 9 CITY: GEORGETOWN STATE: KY ZIP: 40324 BUSINESS PHONE: 6067963001 COMPANY DATA: COMPANY CONFORMED NAME: JENKINS WILBUR CENTRAL INDEX KEY: 0001082225 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] DIRECTOR STATE OF INCORPORATION: KY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 1482 CINCINNATI ROAD CITY: GEORGETOWN STATE: KY ZIP: 40324 MAIL ADDRESS: STREET 1: 1482 CINCINNATI ROAD CITY: GEORGETOWN STATE: KY ZIP: 40324 5 1 0001.txt FORM 5
------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL WASHINGTON, D.C. 20549 ------------------------- FORM 5 OMB Number 3235-0362 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Expires: February 1, 1994 / / Check box if no longer Extimated average burden subject to Section 16. hours per response....1.0 Form 4 or Form 5 obli- Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the gations may continue. Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company See Instruction 1(b). Act of 1940. / / Form 3 Holdings Reported / / Form 4 Transactions Reported - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Jenkins Wilbur M. Premier Financial Bancorp, Inc. - PFBI X Director 10% Owner - ---------------------------------------- ---------------------------------------- --- --- (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for Officer (give Other Number of Reporting Month/Year --- title --- (specify Person (Voluntary) below below) 1482 Cincinnati Road 12/2000 ----------------------------------- - ---------------------------------------- ----------- ---------- (Street) 5. If Amendment, Date of Original (Month/Year) ---------- Georgetown KY 40324 - ---------------------------------------- (City) (State) (Zip Code) - ------------------------------------------------------------------------------------------------------------------------------------ TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature of (Instr. 3) action action or Disposed of (D) Securities ship Indirect Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial (Instr. 8) Owned at Direct Ownership (Month/ end of (D) or (Instr. 4) Day/ --------------------------------------- issuer's Indirect Year) Amount (A) or Price Fiscal Year (I) (D) (Instr. 3 and 4) (Instr.4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/--/00 1500 D 6.00 125,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ (Over) Reminder: Report on a separtate line for each class of securities beneficially owned directly or indirectly. SEC 2270 (3/91) (Print or Type Responses)
FORM 5 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- (Instr. 3) sion or action action Derivative cisable and Exercise Date Code Securities Ac- Expiration Price of (Month/ (Instr. 8) quired (A) or Date Deriv- Day/ Disposed of Month/Day/ ative Year) (D) Year) Security (Instr. 3, 4, and 5) ------------------- Date Expir- ---------------------- Exer- ation (A) (D) cisable Date - ------------------------------------------------------------------------------------------------------------------------------------ NONE - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 7. Title and Amount of Under- 8. Price 9. Number 10. Owner- 11. Nature lying Securities of of Deriv- ship of Indirect (Instr. 3 and 4) Deriv- ative of Deriv- Beneficial ative Securities ative Security: Ownership Security Beneficially Direct (D) or (Instr. 4) --------------------------- (Instr. 5) Owned at Indirect (I) End of Year (Instr. 4) Amount or (Instr. 4) Title Number of Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: /s/ Wilbur Jenkins 01/17/01 ------------------------------- ---------- **Intentional misstatements or omissions of facts constitute **Signature of Reporting Person Date 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 provided is insufficient, see Instruction 6 for procedure.
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