-----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, DWCOyvSUDK9ZzS2JPLRWBk7v8uBrsVwgl5WUgGolWJwW+0dVoc2pAsgTXAaT/UxC nx5YTkbB19BPuBf8DhwHTg== 0000950152-02-007069.txt : 20020918 0000950152-02-007069.hdr.sgml : 20020918 20020918142628 ACCESSION NUMBER: 0000950152-02-007069 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020916 FILED AS OF DATE: 20020918 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: TOTH STEPHEN J CENTRAL INDEX KEY: 0001183453 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O BANCINSURANCE CORP STREET 2: 250 E BROAD STREET 10TH FL CITY: COLUMBUS STATE: OH ZIP: 43215 BUSINESS PHONE: 6142282800 SUBJECT COMPANY: 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 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-08738 FILM NUMBER: 02766781 BUSINESS ADDRESS: STREET 1: 20 E BROAD ST STREET 2: 4TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 BUSINESS PHONE: 6142282800 MAIL ADDRESS: STREET 1: 20 E. BROAD STREET STREET 2: 4TH FLOOR CITY: COLUMBUS STATE: OH ZIP: 43215 4 1 l96317ae4.htm BANCINSURANCE CORPORATION/STEPHEN J. TOTH FORM 4 Bancinsurance Corporation/Stephen J. Toth Form 4
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 4

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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(h) of the Investment Company Act of 1940

o 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*
2. Issuer Name and Ticker or Trading
Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Toth, Stephen J.
(Last) (First) (Middle)
  Bancinsurance Corporation (BCIS)
 
     
  250 East Broad Street, 10th Floor

(Street)
4. Statement for Month/Day/Year 5. If Amendment, Date of Original (Month/Day/Year)
    September 16, 2002
 
     
    6. Relationship of Reporting Person(s)
to Issuer
(Check All Applicable)
7. Individual or Joint/Group Filing
(Check Applicable Line)
  Columbus, Ohio 43215
(City)        (State)        (Zip)
  o  Director o  10% Owner   x Form Filed by One Reporting Person
    x  Officer (give title below)   o Form Filed by More than One Reporting Person
    o  Other (specify below)  
      Vice President of Operations of Ohio Indemnity Co. (Subsidiary of Issuer)
     

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).


 

                                               

Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

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 Sec-
urities Beneficially
Owned Following
Reported Trans-
action(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   09/16/02     S     2,500   D   $5.05     0      

                         

                         

                         

                         

                         

                         

                         

                         

                         

*   – Securities owned on 9/16/02 following reported transaction.
 

Page 2


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)

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)

                      Code V   (A) (D)

               

               

               

               

               

               

               

               

               

               

Page 3


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date

(Month/Day/Year)
7. Title and Amount
of Underlying Securities

(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 of
Derivative Security:
Direct (D) or
Indirect (I)

(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

                   

                   

                   

                   

                   

                   

                   

                   

                   

                   

Explanation of Responses:

   
/s/ Stephen J. Toth
**Signature of Reporting Person
  9/17/02
Date


**   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.

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