FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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 | OMB Approval OMB Number: 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response….0.5 |
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
(Print or Type Responses) | ||||||||||||
1. Name and Address of Reporting Person* George Kelly W. | 2. Issuer Name and Ticker or Trading Symbol csbb.ob CSB Bancorp, Inc. | 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director 10% Owner X Officer (give title below) Other (specify below) Senior Vice President | ||||||||||
(Last) (First) (Middle) 10787 Shreve Road | 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) | 4. Statement for Month/Day/Year December 31, 2002 | ||||||||||
(Street) Shreve OH 44676 | 5. If Amendment, Date of Original Month/Day/Year | 7. Individual or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person Form filed by More than One Reporting Person | ||||||||||
(City) (State) (Zip) | Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||
1. Title of Security (Inst. 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 Securities Beneficially Owned Following Reported Transactions(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 Stock | *2.0220 | D | ||||||||||
Common Stock | 150.0000 | D | ||||||||||
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).
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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. Trans-action Date (Month/ Day/Yr) | 3A. Deemed Execution Date, if any (Month/ Day/Yr) | 4. Trans-action Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Yr) | 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) | ||||
Code | V | (A) | (D) | Date Exer-cisable | Expir-ation Date | Title | Amount or Number of Shares | ||||||||
Employee Stock Option (Right to Buy) | $16.05 | 12/31/02 | A | 1,000 | (1) | 12/31/12 | Common Stock | 1,000 | 1,000 | D | |||||
Explanation of Responses: (1) The option is fully vested as follows:
Years after the Grant Date
Vested Percentage
Years after the Grant Date
Vested Percentage
Less than 1
0%
At Least 4 but less than 5
80%
At Least 1 but less than 2
20%
At Least 5 but no more than 10
100%
At Least 2 but less than 3
40%
At Least 3 but less than 4
60%
*Allocated to reporting person’s account pursuant to a dividend reinvestment feature of
the CSB Bancorp, Inc. Dividend Reinvestment Plan.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations
/s/Kelly W. George
January 3, 2003
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a)
**Signature of Reporting Person
Date
Kelly W. George
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