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l OMB APPROVAL l
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l OMB Number: 3235-0145 l
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SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G/A
Under the Securities Exchange Act of 1934
(Amendment to 13G)*
HORIZON BANCORP, INC.
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(Name of Issuer)
COMMON STOCK
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(Title of Class of Securities)
440406 10 6
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(CUSIP Number)
Check the following box if a fee is being paid with this statement / /. (A fee
is not required only if the filing person: (1) has a previous statement on file
reporting beneficial ownership of more than five percent of the class of
securities described in Item 1; and (2) has filed no amendment subsequent
thereto reporting beneficial ownership of five percent or less of such class.)
(See Rule 13d-7).
*The remainder of this cover page shall be filled out for a reporting person's
initial filing on this form with respect to the subject class of securities,
and for any subsequent amendment containing information which would alter the
disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be
deemed to be "filed" for the purpose of Section 18 of the Securities Exchange
Act of 1934 ("Act") or otherwise subject to the liabilities of that section of
the Act but shall be subject to all other provisions of the Act (however, see
the Notes).
(Continued on following page(s))
SEC 1745 (9-82) Page 1 of 7 pages
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CUSIP NO. 440406 10 6 13G PAGE 2 OF 7 PAGES
1) NAME OF REPORTING PERSON CAROLYN HEDRICK McCULLOCH
S.S. or I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
###-##-####
2) CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) / /
(b) / /
3) SEC USE ONLY
4) CITIZENSHIP OR PLACE OF ORGANIZATION
UNITED STATES OF AMERICA
NUMBER OF SHARES 5) SOLE VOTING POWER
BENEFICIALLY OWNED
BY EACH REPORTING 15,138
PERSON WITH
6) SHARED VOTING POWER
106,530 (SEE EXHIBIT A)
7) SOLE DISPOSITIVE POWER
15,138
8) SHARED DISPOSITIVE POWER
9) AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
157,926 (Includes 36,258 shares in a
marital trust. Mrs. McCulloch
receives dividend from shares.)
10) CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
11) PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
5.6
12) TYPE OF REPORTING PERSON*
IN
*SEE INSTRUCTION BEFORE FILLING OUT!
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Item 1(a). Name of Issuer:
HORIZON BANCORP, INC.
Item 1(b). Address of Issuer's Principal Executive Offices:
P.O. BOX D
BECKLEY, WEST VIRGINIA 25802-2803
Item 2(a). Name of Person Filing:
CAROLYN HEDRICK McCULLOCH
Item 2(b). Address of Principal Business Office or, if none, Residence:
536 WOODLAWN AVENUE
BECKLEY, WV 25801
Item 2(c). Citizenship:
UNITED STATES OF AMERICA
Item 2(d). Title of Class of Securities:
COMMON STOCK
Item 2(e). CUSIP Number:
440406 10 6
Item 3. If this statement is filed pursuant to Rules 13d-1(b), or 13d-2(b),
check whether the person filing is a:
(Not Applicable)
Page 3 of 7 pages
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Item 4. Ownership:
(a) Amount Beneficially Owned:
157,926
(b) Percent of Class:
5.6
(c) Number of shares as to which such person has:
(i) sole power to vote or to direct the vote
15,138
(ii) shared power to vote or to direct the vote
106,530
(iii) sole power to dispose or to direct the disposition of
15,138
(iv) shared power to dispose or to direct the disposition of
Item 5. Ownership of Five Percent or Less of a Class:
(Not Applicable)
Item 6. Ownership of More than Five Percent on Behalf of Another Person:
(Not Applicable)
Item 7. Identification and Classification of the Subsidiary Which Acquired
the Security Being Reported on by the Parent Holding Company:
(Not Applicable)
Item 8. Identification and Classification of Members of the Group:
(Not Applicable)
Item 9. Notice of Dissolution of Group:
(Not Applicable)
Page 4 of 7 pages
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Item 10. Certification:
(Not Applicable)
Signature
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
FEBRUARY 21, 1996
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Date
/s/ CAROLYN HEDRICK McCULLOCH
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Signature
CAROLYN HEDRICK McCULLOCH
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Name/Title
Page 5 of 7 pages
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POWER OF ATTORNEY
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KNOW ALL MEN BY THESE PRESENTS: That I, POLLY JO MASTERS, have made,
constituted and appointed, and by these presents do hereby make, constitute and
appoint CAROLYN HEDRICK McCULLOCH my true and lawful attorney, to serve with
full power and authority, for me and in my name, place and stead, with the
unrestricted right and power to act in my behalf, as my attorney-in-fact for any
and all matters involving the Bank of Raleigh stock owned by me, including, but
not limited to the right to vote the same, to execute proxies to other persons
for the same, to surrender the same in exchange for stock to which I am entitled
from Raleigh Bankshares, Inc., a corporation, and to receive in its place and
stead stock for the number of shares to which I am entitled in said Raleigh
Bankshares, Inc., a corporation, and, in general, to do in my name and on my
behalf any and all acts or deeds necessary to protect my interest in the
ownership, voting and management of said stock,except that my attorney shall not
have the power or authority to encumber sell or transfer the said stock to other
persons, firms or corporations other than exchange of the same as set forth
above.
My said attorney shall have the same power and authority with regard to
the Raleigh Bankshares, Inc. stock as is granted hereinabove for the Bank of
Raleigh stock.
I hereby ratify and confirm all lawful acts done by my said attorney by
virtue hereof.
This Power of Attorney shall not be affected or terminated by the
subsequent disability or incompetence of the principal.
WITNESS the following signature and seal, this 26th day of January,
1984.
/s/ POLLY JO MASTERS
------------------------ (SEAL)
POLLY JO MASTERS
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STATE OF WEST VIRGINIA
COUNTY OF RALEIGH, TO WIT:
I, Karen E. Lilly, a Notary Public of the said County of RALEIGH, in
and for the County and State aforesaid, do hereby certify that POLLY JO
MASTERS, whose name is signed to the following writing, bearing date the 26th
day of January, 1984 has this day acknowledged the same before me in my said
County and State.
Given under my hand this 26th day of January, 1984.
KAREN E. LILLY
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NOTARY PUBLIC
My commission expires: August 13, 1995
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