0001209191-19-006666.txt : 20190204 0001209191-19-006666.hdr.sgml : 20190204 20190204120028 ACCESSION NUMBER: 0001209191-19-006666 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190201 FILED AS OF DATE: 20190204 DATE AS OF CHANGE: 20190204 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SIEBENMORGEN PAUL S CENTRAL INDEX KEY: 0001199382 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38084 FILM NUMBER: 19562659 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FARMERS & MERCHANTS BANCORP INC CENTRAL INDEX KEY: 0000792966 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 341469491 STATE OF INCORPORATION: OH FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 307-11 N DEFIANCE ST CITY: ARCHBOLD STATE: OH ZIP: 43502 BUSINESS PHONE: 4194462501 MAIL ADDRESS: STREET 1: 307-11 NORTH DEFIANCE ST CITY: ARCHBOLD STATE: OH ZIP: 43502 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-02-01 0 0000792966 FARMERS & MERCHANTS BANCORP INC FMAO 0001199382 SIEBENMORGEN PAUL S 405 QUAIL RUN ARCHBOLD OH 43502 1 1 0 0 President & CEO COMMON 46077 D COMMON 2019-02-01 4 F 0 12000 31.53 D 40430 D COMMON 2019-12-19 4 J 0 1142 0.00 A 41572 I Mother's Trust 12,000 shares representing restricted stock awards issued pursuant to the Company's Long Term Incentive Plan were vested by Mr. Siebenmorgen due to his retirement from the "Company". 5,647 shares were repurchased by the "Company" to cover taxation. The "Company" calculated taxes owed - federal, state, and local on 5,647 shares that were vested on 2/1/2019 as a result of stock awards issued pursuant to the Company's Long Term Incentive plan. Shares are attributable to Paul S. Siebenmorgen being appointed trustee of his mother's trust who is deceased. /s/ Paul S. Siebenmorgen 2019-02-04