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| UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
FORM 144
NOTICE OF PROPOSED SALE OF SECURITIES PURSUANT TO RULE 144 UNDER THE SECURITIES ACT OF 1933
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SEC USE ONLY | |
| DOCUMENT SEQUENCE NO.
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| CUSIP NUMBER
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| WORK LOCATION | ||
| ATTENTION: | Transmit for filing 3 copies of this form concurrently with either placing an order with a broker to execute sale or executing a sale directly with a market maker. |
| 1 (a) NAME OF ISSUER (Please type or print) Farmers & Merchants Bancorp, Inc. |
(b) IRS IDENT. NO. 34-1469491 |
(c) S.E.C. FILE NO. 001-38084 | ||||
| 1 (d) ADDRESS OF ISSUER | STREET | CITY | STATE | ZIP CODE | (e) TELEPHONE NO. | |||||||
| AREA CODE | NUMBER | |||||||||||
| 307 N Defiance St. | Archbold | OH | 43502 | 419 | 446-2501 | |||||||
| 2
(a) NAME OF PERSON FOR WHOSE ACCOUNT Paul S. Siebenmorgen |
(b) RELATIONSHIP TO ISSUER Executive Officer |
(c) ADDRESS STREET
405 Quail Run |
CITY
Archbold |
STATE
OH |
ZIP CODE
43502 |
INSTRUCTION: The person filing this notice should contact the issuer to obtain the I.R.S. Identification Number and the S.E.C. File Number.
| 3 (a) | (b) | SEC USE ONLY | (c) | (d) | (e) | (f) | (g) | |||||||||||||||||||||||||||||||
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Title of the Class of Securities To Be Sold |
Name and Address of Each Broker Through Whom the Securities are to be Offered or Each Market Maker who is Acquiring the Securities
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Broker-Dealer File Number |
Number of Shares or Other Units To Be Sold (See instr. 3(c)) |
Aggregate Market Value
(See instr. 3(d)) |
Number of Shares or Other Units Outstanding (See instr. 3(e)) |
Approximate Date of Sale (See instr. 3(f)) (MO. DAY YR.) |
Name of Each Securities Exchange (See instr. 3(g)) | |||||||||||||||||||||||||||||||
| COMMON | Investment Planners, Inc PO Box 170 Decatur, IL 62525 |
15,000 | $654,000 (3) | 9,284,061 | 9/17/2018 | NASDAQ | ||||||||||||||||||||||||||||||||
| 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. |
SEC 1147 (08-07) |
TABLE I — SECURITIES TO BE SOLD
Furnish the following information with respect to the acquisition of the securities to be sold
and with respect to the payment of all or any part of the purchase price or other consideration therefor:
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Title of the Class |
Date you Acquired |
Nature of Acquisition Transaction |
Name of Person from Whom Acquired (If gift, also give date donor acquired) |
Amount of Securities Acquired |
Date of Payment |
Nature of Payment | ||||||||||||||
| COMMON | 10/7/2004 10/7/2004 9/6/2005
11/22/2005 3/13/2006 9/7/2006
12/8/2006 |
Purchased by Individual IRA Purchased by Joint Stock Award
Purchased by Individual IRA Purchased by Individual IRA Stock Award
Purchased by Individual IRA |
Open Market Open Market Acquired through Company’s Long Term Incentive Plan Open Market Open Market Acquired through Company’s Long Term Incentive Plan Open Market |
2,832 (1) (2) 2,400 (1) (2) 800 (1) (2)
2,000 (1) (2) 3,168 (1) (2) 1,200 (2)
4,000 (2) |
10/7/2004 10/7/2004 N/A
11/22/2005 3/13/2006 N/A
12/8/2006 |
Cash Cash N/A
Cash Cash N/A
Cash | ||||||||||||||
| INSTRUCTIONS: | If the securities were purchased and full payment therefor was not made in cash at the time of purchase, explain in the table or in a note thereto the nature of the consideration given. If the consideration consisted of any note or other obligation, or if payment was made in installments describe the arrangement and state when the note or other obligation was discharged in full or the last installment paid. | |||||||||||||||||||
| TABLE II — SECURITIES SOLD DURING THE PAST 3 MONTHS
Furnish the following information as to all securities of the issuer sold during the past 3 months by the person for whose account the securities are to be sold.
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| Name and Address of Seller | Title of Securities Sold | Date of Sale | Amount of Securities Sold |
Gross Proceeds | ||||||||||||||||
| REMARKS: | Footnote (1) - All shares indicated reflect a 4-for-1 split of the Issuer’s Common Stock which became effective 5/12/2006. | |||
| Footnote (2) - All shares indicated reflect a 2-for 1 split of the Issuer’s Common Stock which became effective 9/20/2017. | ||||
| Footnote (3) - Based on the closing price of the Issuer’s Common Stock on the NASDAQ stock market on September 13, 2018 | ||||
| INSTRUCTIONS: See the definition of “person” in paragraph (a) of Rule 144. Information is to be given not only as to the person for whose account the securities are to be sold but also as to all other persons included in that definition. In addition, information shall be given as to sales by all persons whose sales are required by paragraph (e) of Rule 144 to be aggregated with sales for the account of the person filing this notice. |
ATTENTION: The person for whose account the securities to which this notice relates are to be sold hereby represents by signing this notice that he does not know any material adverse information in regard to the current and prospective operations of the Issuer of the securities to be sold which has not been publicly disclosed. If such person has adopted a written trading plan or given trading instructions to satisfy Rule 10b5-1 under the Exchange Act, by signing the form and indicating the date that the plan was adopted or the instruction given, that person makes such representation as of the plan adoption or instruction date. | |
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9/14/2018 DATE OF NOTICE |
/s/ Paul S. Siebenmorgen (SIGNATURE) | |
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DATE OF PLAN ADOPTION OR GIVING OF INSTRUCTION, IF RELYING ON RULE 10B5-1 |
The notice shall be signed by the person for whose account the securities are to be sold. At least one copy of the notice shall be manually signed. Any copies not manually signed shall bear typed or printed signatures. | |
| ATTENTION: Intentional misstatements or omission of facts constitute Federal Criminal Violations (See 18 U.S.C. 1001) |
SEC 1147 (02-08)