-----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, HimCbzz7fLMqL1j8tgs8YBoMZWmDWO/xlo/+rUgpl9fQYFK8lXkW8WIxZRrM147w xrpdNXMbpt4HDAe3OXHHiw== /in/edgar/work/20000807/0000887919-00-000016/0000887919-00-000016.txt : 20000921 0000887919-00-000016.hdr.sgml : 20000921 ACCESSION NUMBER: 0000887919-00-000016 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000707 FILED AS OF DATE: 20000807 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PREMIER FINANCIAL BANCORP INC CENTRAL INDEX KEY: 0000887919 STANDARD INDUSTRIAL CLASSIFICATION: [6022 ] IRS NUMBER: 611206757 STATE OF INCORPORATION: KY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-20908 FILM NUMBER: 687258 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: BURNS EDSEL R CENTRAL INDEX KEY: 0001119797 STANDARD INDUSTRIAL CLASSIFICATION: [ ]DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 115 N HAMILTON ST STREET 2: P O BOX 9 CITY: GEORGETOWN STATE: KY ZIP: 40324 BUSINESS PHONE: 6067963001 MAIL ADDRESS: STREET 1: 4350 COUNTY ROAD 31 CITY: CHESAPEAKE STATE: OH ZIP: 45619 3 1 0001.txt FORM 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 (Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event Re- 4.Issuer Name and Ticker or Trading Symbol quiring Statement Premier Financial Bancorp, Inc. - PFBI ----------------------------------------------------------- Burns Edsel R (Month/Day/Year) - ---------------------------------------- 06/21/00 5.Relationship of Reporting Person(s) 6. If Amendment, Date to Issuer (Check all applicable) of Original (Last) (First) (Middle) 3. IRS or Social Se- X Director 10% Owner curity Number of --- --- -------------------- 4350 County Road 31 Reporting Person Officer (give Other (specify - ---------------------------------------- (Voluntary) title below) below) 7. Individual or (Street) --- --- Joint/Group Filing (Check Applicable Line) ---------------------------- Form filed by One X Reporting Person --- Form filed by More than One Reporting Person Chesapeake OH 45619 --- - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip Code) TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5) (Instr. 4) (D)or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 787 I Jointly with spouse - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ *If the form is filed by more than one reporting person, see instruction 4(b)(v). (Over) Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. SEC 1473 (7/97)
FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------------------------------------------------------------ 1.Title of Derivative Security 2.Date Exercisable and 3.Title and Amount of Securities 4.Conversion or 5.Ownership 6. Nature of (Instr. 4) Expiration Date Derivative Security Exercise Price Form of Indirect (Month/Day/Year) (Instr.4) of Derivative Derivative (Instr. 5) Security Security Direct (D) or Date Expiration Title Amount or Indirect (I) Exercisable Date Number of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: /s/ Edsel R Burns 07/07/00 ------------------------------- -------- **Intentional misstatements or omissions of facts constitute Federal Criminal Violations **Signature of Reporting Person Date 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. Page 2 SEC 1473 (7-97)
-----END PRIVACY-ENHANCED MESSAGE-----