<SEC-DOCUMENT>0001193125-18-176201.txt : 20180529
<SEC-HEADER>0001193125-18-176201.hdr.sgml : 20180529
<ACCEPTANCE-DATETIME>20180529103702
ACCESSION NUMBER:		0001193125-18-176201
CONFORMED SUBMISSION TYPE:	8-K
PUBLIC DOCUMENT COUNT:		2
CONFORMED PERIOD OF REPORT:	20180522
ITEM INFORMATION:		Departure of Directors or Certain Officers; Election of Directors; Appointment of Certain Officers: Compensatory Arrangements of Certain Officers
ITEM INFORMATION:		Financial Statements and Exhibits
FILED AS OF DATE:		20180529
DATE AS OF CHANGE:		20180529

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			MIDDLEFIELD BANC CORP
		CENTRAL INDEX KEY:			0000836147
		STANDARD INDUSTRIAL CLASSIFICATION:	STATE COMMERCIAL BANKS [6022]
		IRS NUMBER:				341585111
		STATE OF INCORPORATION:			OH

	FILING VALUES:
		FORM TYPE:		8-K
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	001-36613
		FILM NUMBER:		18863227

	BUSINESS ADDRESS:	
		STREET 1:		15985 E HIGH ST
		STREET 2:		P O BOX 35
		CITY:			MIDDLEFILED
		STATE:			OH
		ZIP:			44062-9263
		BUSINESS PHONE:		4406321666

	MAIL ADDRESS:	
		STREET 1:		15985 EAST HIGH STREET
		STREET 2:		P O BOX 35
		CITY:			MIDDLEFIELD
		STATE:			OH
		ZIP:			44062-9263
</SEC-HEADER>
<DOCUMENT>
<TYPE>8-K
<SEQUENCE>1
<FILENAME>d595707d8k.htm
<DESCRIPTION>FORM 8-K
<TEXT>
<HTML><HEAD>
<TITLE>Form 8-K</TITLE>
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 <P STYLE="line-height:1.0pt;margin-top:0pt;margin-bottom:0pt;border-bottom:1px solid #000000">&nbsp;</P>
<P STYLE="line-height:3.0pt;margin-top:0pt;margin-bottom:2pt;border-bottom:1px solid #000000">&nbsp;</P> <P STYLE="margin-top:4pt; margin-bottom:0pt; font-size:18pt; font-family:Times New Roman" ALIGN="center"><B>UNITED STATES </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:18pt; font-family:Times New Roman" ALIGN="center"><B>SECURITIES AND EXCHANGE COMMISSION </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:12pt; font-family:Times New Roman" ALIGN="center"><B>Washington, DC 20549 </B></P> <P STYLE="font-size:10pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P><center>
<P STYLE="line-height:6.0pt;margin-top:0pt;margin-bottom:2pt;border-bottom:1.00pt solid #000000;width:21%">&nbsp;</P></center> <P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:18pt; font-family:Times New Roman" ALIGN="center"><B>FORM <FONT
STYLE="white-space:nowrap">8-K</FONT> </B></P> <P STYLE="font-size:10pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P><center>
<P STYLE="line-height:6.0pt;margin-top:0pt;margin-bottom:2pt;border-bottom:1.00pt solid #000000;width:21%">&nbsp;</P></center> <P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:12pt; font-family:Times New Roman" ALIGN="center"><B>CURRENT
REPORT </B></P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:12pt; font-family:Times New Roman" ALIGN="center"><B>Pursuant to Section&nbsp;13 or 15(d) </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:12pt; font-family:Times New Roman" ALIGN="center"><B>of The Securities Exchange Act of 1934 </B></P>
<P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:12pt; font-family:Times New Roman" ALIGN="center"><B>Date of Report (date of earliest event reported): May&nbsp;22, 2018 </B></P>
<P STYLE="font-size:10pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P><center> <P STYLE="line-height:6.0pt;margin-top:0pt;margin-bottom:2pt;border-bottom:1.00pt solid #000000;width:21%">&nbsp;</P></center>
<P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:24pt; font-family:Times New Roman" ALIGN="center"><B>Middlefield Banc Corp. </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>(Exact name of registrant specified in its charter) </B></P> <P STYLE="font-size:10pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P><center>
<P STYLE="line-height:6.0pt;margin-top:0pt;margin-bottom:2pt;border-bottom:1.00pt solid #000000;width:21%">&nbsp;</P></center> <P STYLE="font-size:10pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
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<TD VALIGN="top" ALIGN="center"><B>Ohio</B></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top" ALIGN="center"><B><FONT STYLE="white-space:nowrap">001-36613</FONT></B></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top" ALIGN="center"><B><FONT STYLE="white-space:nowrap">34-1585111</FONT></B></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:8pt">
<TD VALIGN="top" ALIGN="center"> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:8pt; font-family:Times New Roman" ALIGN="center"><B>(State or other jurisdiction</B></P>
<P STYLE="margin-top:0pt; margin-bottom:1pt; font-size:8pt; font-family:Times New Roman" ALIGN="center"><B>of incorporation)</B></P></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top" ALIGN="center"> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:8pt; font-family:Times New Roman" ALIGN="center"><B>(Commission</B></P>
<P STYLE="margin-top:0pt; margin-bottom:1pt; font-size:8pt; font-family:Times New Roman" ALIGN="center"><B>File Number)</B></P></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top" ALIGN="center"> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:8pt; font-family:Times New Roman" ALIGN="center"><B>(IRS Employer</B></P>
<P STYLE="margin-top:0pt; margin-bottom:1pt; font-size:8pt; font-family:Times New Roman" ALIGN="center"><B>Identification No.)</B></P></TD></TR>
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<TD VALIGN="top" COLSPAN="3" ALIGN="center"><B>15985 East High Street, Middlefield, Ohio</B></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top" ALIGN="center"><B><FONT STYLE="white-space:nowrap">44062-0035</FONT></B></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:8pt">
<TD VALIGN="top" COLSPAN="3" ALIGN="center"><B>(Address of principal executive offices)</B></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top" ALIGN="center"><B>(Zip Code)</B></TD></TR>
</TABLE> <P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>Registrant&#146;s telephone number, including area code (440)
<FONT STYLE="white-space:nowrap">632-1666</FONT> </B></P> <P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>[not applicable] </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:8pt; font-family:Times New Roman" ALIGN="center"><B>(Former name or former address, if changed since last report) </B></P>
<P STYLE="font-size:10pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P><center> <P STYLE="line-height:6.0pt;margin-top:0pt;margin-bottom:2pt;border-bottom:1.00pt solid #000000;width:21%">&nbsp;</P></center>
<P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Check the appropriate box below if the Form <FONT STYLE="white-space:nowrap">8-K</FONT> filing is intended to simultaneously satisfy the filing obligation of
the registrant under any of the following provisions (see General Instruction A.2. below): </P> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="4%" VALIGN="top" ALIGN="left">&#9744;</TD>
<TD ALIGN="left" VALIGN="top">Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) </TD></TR></TABLE> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="4%" VALIGN="top" ALIGN="left">&#9744;</TD>
<TD ALIGN="left" VALIGN="top">Soliciting material pursuant to Rule <FONT STYLE="white-space:nowrap">14a-12</FONT> under the Exchange Act (17 CFR <FONT STYLE="white-space:nowrap">240.14a-12)</FONT> </TD></TR></TABLE>
<P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="4%" VALIGN="top" ALIGN="left">&#9744;</TD>
<TD ALIGN="left" VALIGN="top"><FONT STYLE="white-space:nowrap">Pre-commencement</FONT> communications pursuant to Rule <FONT STYLE="white-space:nowrap">14d-2(b)</FONT> under the Exchange Act (17 CFR
<FONT STYLE="white-space:nowrap">240.14d-2(b))</FONT> </TD></TR></TABLE> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="4%" VALIGN="top" ALIGN="left">&#9744;</TD>
<TD ALIGN="left" VALIGN="top"><FONT STYLE="white-space:nowrap">Pre-commencement</FONT> communications pursuant to Rule <FONT STYLE="white-space:nowrap">13e-4(c)</FONT> under the Exchange Act (17 CFR
<FONT STYLE="white-space:nowrap">240.13e-4(c))</FONT> </TD></TR></TABLE> <P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Indicate by check mark whether the registrant is an emerging growth company as
defined in Rule 405 of the Securities Act of 1933 (17 CFR &#167;230.405) or Rule <FONT STYLE="white-space:nowrap">12b-2</FONT> of the Securities Exchange Act of 1934 (17 CFR <FONT STYLE="white-space:nowrap">&#167;240.12b-2).</FONT> </P>
<P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Emerging growth company&nbsp;&nbsp;&#9744; </P> <P STYLE="margin-top:10pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">If an emerging
growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section&nbsp;13(a) of the Exchange
Act.&nbsp;&nbsp;&#9744; </P> <P STYLE="font-size:10pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P> <P STYLE="line-height:1.0pt;margin-top:0pt;margin-bottom:0pt;border-bottom:1px solid #000000">&nbsp;</P>
<P STYLE="line-height:3.0pt;margin-top:0pt;margin-bottom:2pt;border-bottom:1px solid #000000">&nbsp;</P>

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<TD WIDTH="12%" VALIGN="top" ALIGN="left"><B>Item&nbsp;5.02(e)</B></TD>
<TD ALIGN="left" VALIGN="top"><B>Compensatory Arrangements of Certain Officers </B></TD></TR></TABLE> <P STYLE="margin-top:6pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">On May&nbsp;22, 2018 Middlefield Banc
Corp. made conditional stock awards to officers and employees, including President and CEO Thomas G. Caldwell (nominal award: 2,240 shares), Executive Vice President and Chief Operating Officer James R. Heslop, II (nominal award: 1,202 shares), and
Senior Vice President, Chief Financial Officer and Treasurer Donald L. Stacy (nominal award: 1,015 shares). The award amount is a percentage of the award recipient&#146;s salary, divided by the share price at the end of 2017. The closing price of
the shares on December&nbsp;31, 2017 was $48.20. The percentage of salary for purposes of calculating the award to Messrs. Caldwell, Heslop, and Stacy is 30% for Mr.&nbsp;Caldwell and 25% for Messrs. Heslop and Stacy. Including the conditional stock
awards of Messrs. Caldwell, Heslop, and Stacy, a nominal award total of 9,952 shares was made to officers and employees. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">The award
recipient will not become the owner of and entitled to the shares unless two conditions are satisfied: a service condition and a performance condition. The conditional share awards do not confer on the recipient any shareholder rights, including the
right to vote or the right to cash dividends, until the conditions are satisfied or waived. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">The award recipient must maintain service
with Middlefield Banc Corp. and affiliates until the third anniversary of the award to satisfy the service condition, but the service condition is waived if the recipient dies or becomes disabled before that date or if a change in control of
Middlefield Banc Corp. occurs before that date. The performance condition will be satisfied if the average annual return on Middlefield Banc Corp. stock for the years 2018, 2019, and 2020 is at least 8.00%. For this purpose annual return is the sum
of annual dividends and the excess of the closing stock price on the final trading day of the year over the closing price on the final trading day of the preceding year, divided by the closing stock price on the final trading day of the preceding
year. The three-year average of the annual returns for 2018, 2019, and 2020 will determine whether the 8.00% goal is satisfied. If the 8.00% goal is not satisfied but the average annual return is positive, the recipient will become the owner of and
entitled to a portion of the conditional stock award, forfeiting the remainder. The portion that will be issued to the recipient is the percentage of the total award equal to the percentage achievement of the 8.00% goal. If the average annual return
is negative, the entire award is forfeited, unless the Compensation Committee waives the performance condition. If average annual return exceeds 8.00%, the nominal amount of the conditional stock award will increase, up to a maximum of 125% of the
nominal award, increasing based on the percentage excess of actual average return over the 8.00% goal. Accordingly, the maximum potential conditional stock award total is 12,434 shares, including a maximum for Mr.&nbsp;Caldwell of 2,800 shares, for
Mr.&nbsp;Heslop of 1,502 shares, and for Mr.&nbsp;Stacy of 1,268 shares. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">The agreement includes a
<FONT STYLE="white-space:nowrap">one-year</FONT> prohibition against competition after employment termination. This summary of the agreement&#146;s terms is qualified in its entirety by reference to the copy of the form of conditional stock award
agreement attached as an exhibit. </P> <P STYLE="font-size:18pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
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<TD WIDTH="12%" VALIGN="top" ALIGN="left"><B>Item&nbsp;9.01(d)</B></TD>
<TD ALIGN="left" VALIGN="top"><B>Exhibits. </B></TD></TR></TABLE> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
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<TD VALIGN="top" NOWRAP>10.29</TD>
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<TD VALIGN="top"><A HREF="d595707dex1029.htm">form of conditional stock award agreement </A></TD></TR>
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 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>Signatures </B></P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by
the undersigned hereunto duly authorized. </P> <P STYLE="font-size:12pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
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<TD VALIGN="bottom"><B>Middlefield Banc Corp.</B></TD></TR>
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<TD VALIGN="top">Date: May&nbsp;29, 2018</TD>
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<TD VALIGN="bottom"> <P STYLE="margin-top:0pt; margin-bottom:1pt; border-bottom:1px solid #000000; font-size:10pt; font-family:Times New Roman">/s/ James R. Heslop, II</P></TD></TR>
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<TD VALIGN="bottom">&nbsp;</TD>
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<TD VALIGN="bottom">&nbsp;</TD>
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<TD VALIGN="bottom">James R. Heslop, II</TD></TR>
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<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
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<TD VALIGN="bottom">Executive Vice President and COO</TD></TR>
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<DOCUMENT>
<TYPE>EX-10.29
<SEQUENCE>2
<FILENAME>d595707dex1029.htm
<DESCRIPTION>EX-10.29
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 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="right"><B>Exhibit 10.29 </B></P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>M<SMALL>IDDLEFIELD</SMALL> B<SMALL>ANC</SMALL> C<SMALL>ORP</SMALL>. </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>2017 O<SMALL>MNIBUS</SMALL> E<SMALL>QUITY</SMALL> P<SMALL>LAN</SMALL> </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>S<SMALL>TOCK</SMALL> A<SMALL>WARD</SMALL> A<SMALL>GREEMENT</SMALL> </B></P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>1</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Number of Shares Awarded</B>. Middlefield Banc Corp. (&#147;<B>Middlefield</B>&#148;), an Ohio
corporation, hereby awards to &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (the &#147;<B>Participant</B>&#148;) the right to become the owner of
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; shares of Middlefield common stock if the terms and conditions of this Stock Award Agreement are satisfied, subject to a potential increase to as many as
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<U></U> shares (125% maximum) based on satisfaction of the performance conditions of section 3(b). The number of shares awarded will be adjusted by the Plan Committee to account
for stock dividends, stock splits, or other changes in capital structure. The Participant is not and will not be the owner of the shares and the shares are not and will not be outstanding until the date when the conditions to the Participant&#146;s
entitlement to the shares are satisfied, as provided in section 3. This award is subject to the terms and conditions of the 2017 Omnibus Equity Plan and this Stock Award Agreement. Terms that are defined in the 2017 Omnibus Equity Plan are used in
this Stock Award Agreement as they are defined in the 2017 Omnibus Equity Plan. By entering into this Stock Award Agreement the Participant agrees to the post-employment restrictions of section 14. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>2</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Date of the Award</B>. The date of this Stock Award Agreement is
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;, 2018. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>3</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>The Award is
Conditional and is Subject to Forfeiture</B>. The award and the Participant&#146;s right to become the owner of the shares are subject to two conditions, are subject to forfeiture if the conditions are not satisfied, and will not be considered
vested until the conditions are satisfied or waived. The two conditions consist of a service condition and a performance condition. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(a)&nbsp;&nbsp;&nbsp;&nbsp;<I>Service condition</I>. To become owner of the shares awarded by section 1 the Participant must
maintain continuous employment with Middlefield or a Related Entity for three years after the date of this Stock Award Agreement, except in the case of termination within three years occurring because of death or disability and except for a Change
in Control occurring within three years after the date of this Stock Award Agreement. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(1)&nbsp;&nbsp;&nbsp;&nbsp;<I>Continuous employment for three years</I>. If the Participant maintains continuous employment
with Middlefield or a Related Entity until the third anniversary of the date of this Stock Award Agreement, the portion of the shares awarded by section 1 for which the performance conditions of section 3(b) are satisfied will be vested and <FONT
STYLE="white-space:nowrap">non-forfeitable,</FONT> the Participant will be the owner of the vested shares, and the Participant will then possess all right, title, and interest in the shares. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(2)&nbsp;&nbsp;&nbsp;&nbsp;<I>Exception for death or disability</I>. If the Participant&#146;s employment ends before the third
anniversary because of death or disability, the service condition will be waived and the Participant or the Participant&#146;s estate or designated beneficiary will be entitled to and vested in a portion of the shares awarded under section 1 based
on the degree to which the performance conditions stated in section 3(b) are satisfied on the date of the Participant&#146;s death or the date on which the Participant&#146;s employment terminated because of disability. For purposes of this Stock
Award Agreement the term &#147;<B>disability</B>&#148; means, because of a medically determinable physical or mental impairment that can be expected to result in death or that can be expected to last for a continuous period of at least 12 months,
(<I>x</I>)&nbsp;the Participant is unable to engage in any substantial gainful activity, or (<I>y</I>)&nbsp;the Participant is receiving income replacement benefits for a period of at least three months under an accident and health plan of the
employer. Medical determination of disability may be made either by the Social Security Administration or by the provider of an accident or health plan covering employees of Middlefield or Related Entity. Upon request of the Plan Committee, the
Participant must submit proof to the Plan Committee of the Social Security Administration&#146;s or provider&#146;s determination. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(3)&nbsp;&nbsp;&nbsp;&nbsp;<I>Exception for a Change in Control</I>. If a Change in Control occurs before the third
anniversary, the service condition will be waived, the performance condition of section 3(b) will be waived, and when the Change in Control occurs the Participant will be entitled to and vested in the shares awarded under section 1
(<I>i</I>.<I>e</I>., the number of shares first stated in section 1, not the 125% to which the award may be increased), provided the Participant remains employed by Middlefield or Related Entity on that date. </P>
 <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">1 </P>


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 <P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(4)&nbsp;&nbsp;&nbsp;&nbsp;<I>Effect of failure to satisfy the service condition;
Plan Committee&#146;s right to waive conditions to vesting</I>. If the Participant does not maintain continuous employment with Middlefield or a Related Entity until the third anniversary of the date of this Stock Award Agreement the section 1 award
shall be forfeited in its entirety as of the date the Participant&#146;s employment terminates, except as provided in section 3(a)(2) for termination because of death or disability and except as provided in section 3(a)(3) for a Change in Control.
In its sole discretion, however, the Plan Committee may elect to accelerate the Participant&#146;s vesting in and right to all or a portion of the award when the Participant&#146;s employment terminates, waiving in whole or in part the service
condition of section 3(a), the performance condition of section 3(b), or both. </P> <P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(b)&nbsp;&nbsp;&nbsp;&nbsp;<I>Performance
condition</I>. In addition to the service condition of section 3(a), to become owner of and vested in the shares awarded by section 1 the performance conditions of this section 3(b) must be satisfied, except as provided in section 3(a)(3) in the
case of a Change in Control. The performance condition that must be satisfied to become the owner of and vested in 100% of the shares awarded by section 1 is achievement of an annual average total shareholder return of 8.00% or more in the
three-year performance period beginning on January&nbsp;1, 2018 and ending on December&nbsp;31, 2020 (or on the date of employment termination if employment terminates because of death or disability), which is referred to hereinafter as the
&#147;<B>performance period</B>.&#148; Total shareholder return means the change in the closing price of Middlefield common stock on the final trading day of the year over the closing price on the final trading day of the preceding year, divided by
the closing price on the final trading day of the preceding year, and taking into account cash dividends during the period. If the annual average total shareholder return for the performance period is positive but less than the goal of 8.00%, the
Participant will become owner of and vested in a percentage of the shares awarded by section 1 equal to the percentage achievement of the 8.00% goal. Shares will be rounded to the nearest whole number. No fractional shares will be issued. If the
annual average total shareholder return for the performance period is negative, the Participant will forfeit all shares awarded. If the annual average total shareholder return for the performance period exceeds 8.00%, the number of shares awarded
will increase based on the percentage excess of average annual total shareholder return over the 8.00% goal, up to a maximum of 125%. Exhibit A contains an illustration of the calculation of average total shareholder return. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(c)&nbsp;&nbsp;&nbsp;&nbsp;<I>Plan Committee determinations</I>. The Plan Committee has exclusive authority to perform all
calculations that are necessary and exclusive authority to make all determinations that are necessary under this Stock Award Agreement, including but not limited to calculating closing prices, annual return, and average annual total shareholder
return. The Plan Committee may delegate its authority. Actions of the Plan Committee are final and binding. To prevent dilution or enlargement of the benefit intended to be granted to the Participant by this Stock Award Agreement, the Plan Committee
will modify the award of shares under section 1 and total shareholder return calculations under section 3(b) to account for stock dividends, stock splits, and other changes in capitalization occurring during the performance period. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>4</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>The Shares Are Not Transferable While Subject to Forfeiture</B>. Until the shares awarded by section 1
become vested and <FONT STYLE="white-space:nowrap">non-forfeitable</FONT> under section 3, the Participant is not the owner of and is not permitted to sell, transfer, pledge, assign, or otherwise alienate or hypothecate any of the shares or any
interest in the shares. Until that time, Middlefield is entitled to disregard any attempt by the Participant to sell, transfer, pledge, assign, or otherwise alienate or hypothecate any of the shares or any interest in the shares, and any such sale,
transfer, pledge, assignment, or other alienation or hypothecation is void and of no force or effect. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>5</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Rights as a Stockholder</B>. Until the conditions of section 3 are satisfied the Participant will have
none of the associated rights of a stockholder under Ohio law and Middlefield&#146;s Articles of Incorporation and Code of Regulations. Until the conditions of section 3 are satisfied the Participant will not be entitled to exercise voting power and
will not be entitled to cash dividends declared by Middlefield&#146;s board of directors. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>6</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>The 2017
Omnibus Equity Plan Governs</B>. The award of shares and this Stock Award Agreement are subject to the terms and conditions of the 2017 Omnibus Equity Plan, as well as any rules of the Plan Committee under the 2017 Omnibus Equity Plan. The
Participant acknowledges having received a copy of the 2017 Omnibus Equity Plan. The Participant is familiar with the terms and provisions of the 2017 Omnibus Equity Plan and accepts this award subject to all the terms and provisions of the 2017
Omnibus Equity Plan. The Participant agrees to accept as binding, conclusive, and final all decisions or interpretations of Middlefield&#146;s board of directors or Plan Committee having to do with the 2017 Omnibus Equity Plan or this Stock Award
Agreement. </P>
 <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">2 </P>


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 <P STYLE="margin-top:0pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>7.</B>&nbsp;&nbsp;&nbsp;&nbsp;<B>Certificates</B>. Provided book entry registration is allowed
by Middlefield&#146;s Articles of Incorporation and Code of Regulations, Middlefield may record the Participant&#146;s ownership of the shares using a book entry system rather than issuing certificates. If certificates are issued, they will bear any
restrictive legends that Middlefield considers necessary or desirable. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>8</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Entire Agreement</B>. This
Stock Award Agreement and the 2017 Omnibus Equity Plan supersede any and all other prior understandings and agreements, either oral or in writing, between the parties concerning the subject matter and constitute the sole agreement between the
parties relating to the subject matter. All prior negotiations and agreements between the parties concerning the subject matter of this Stock Award Agreement are merged in this Stock Award Agreement. Each party to this Stock Award Agreement
acknowledges that no representations, inducements, promises, or agreements concerning the shares have been made by any party or by anyone acting on behalf of any party that are not contained in this Stock Award Agreement or in the 2017 Omnibus
Equity Plan. Each party acknowledges that any agreement, statement, or promise concerning the shares that is not contained in this Stock Award Agreement or the 2017 Omnibus Equity Plan is not valid, is not binding, and is of no force or effect. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>9</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Modification</B>. Middlefield may change or modify this Stock Award Agreement without the
Participant&#146;s consent or signature if in its sole discretion Middlefield determines that the change or modification is necessary to comply with or to be exempt from the requirements of the Internal Revenue Code of 1986, including but not
limited to section 409A of the Internal Revenue Code of 1986 or any regulations or other Department of Treasury guidance of general application issued under the Internal Revenue Code of 1986. Middlefield may amend the 2017 Omnibus Equity Plan to the
extent permitted by the 2017 Omnibus Equity Plan. The Plan Committee also may modify the award as provided in section 3. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>10</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Headings</B>. The headings in this Stock Award Agreement are solely for convenience of reference and do
not affect the interpretation of this Stock Award Agreement. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>11</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Notice</B>. All written notices,
requests, and other communications hereunder will be duly given if delivered by hand or mailed, certified or registered mail, return receipt requested, with postage prepaid, to the following addresses or to such other address as either party may
designate by like notice. If to Middlefield, notice must be given to Middlefield Banc Corp., 15985 East High Street, P.O. Box 35, Middlefield, Ohio 44062, Attention: Chief Financial Officer, or to such other address as Middlefield designates to the
Participant in writing. If to the Participant, notice must be given to the Participant at the Participant&#146;s address appearing on the signature page of this Stock Award Agreement, or to such other address as the Participant designates to
Middlefield. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>12</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Taxes</B>. The Participant is hereby advised to consult immediately with his or her own
tax advisor about the tax consequences of this Stock Award Agreement, the method and timing for filing an election to include this award in income under section 83(b) of the Internal Revenue Code of 1986, and the tax consequences of that election.
By executing this Stock Award Agreement, the Participant agrees that if the Participant makes an election to include the award in income under section 83(b) of the Internal Revenue Code of 1986, the Participant will provide Middlefield with written
notice of the election in accordance with the regulations under section 83(b) of the Internal Revenue Code of 1986. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>13</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>No Registration Rights</B>. The Participant acknowledges and agrees that Middlefield and its Related
Entities have no obligation to register the Participant&#146;s offer and sale of the shares awarded under this Stock Award Agreement under the Securities Act of 1933 or the securities laws of any state. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>14</B>.&nbsp;&nbsp;&nbsp;&nbsp;<B>Post-employment restrictions</B>. The restrictions in this section 14 have been negotiated, presented to,
and accepted by the Participant contemporaneous with the offer and acceptance by the Participant of this Stock Award Agreement. </P>
 <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">3 </P>


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 <P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(a)&nbsp;&nbsp;&nbsp;&nbsp;<I>Promise of no solicitation</I>. The Participant
promises and agrees that during the Restricted Period (as defined below) and in the Restricted Territory (as defined below) the Participant will<SUP STYLE="font-size:85%; vertical-align:top">1</SUP>: </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(1)&nbsp;&nbsp;&nbsp;&nbsp;<B>not </B>directly or indirectly solicit or attempt to solicit any Customer (as defined below) to
accept or purchase Financial Products or Services (as defined below) of the same nature, kind, or variety as provided to the Customer by Middlefield or a Related Entity during the two years immediately before the Participant&#146;s employment
termination with Middlefield or a Related Entity, </P> <P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(2)&nbsp;&nbsp;&nbsp;&nbsp;<B>not</B> directly or indirectly influence
or attempt to influence any Customer, joint venturer, or other business partner of Middlefield or a Related Entity to alter that person or entity&#146;s business relationship with Middlefield or the Related Entity in any respect, and </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(3)&nbsp;&nbsp;&nbsp;&nbsp;<B>not </B>accept the Financial Products or Services business of any Customer or provide Financial
Products or Services to any Customer on behalf of anyone other than Middlefield or a Related Entity. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(b)&nbsp;&nbsp;&nbsp;&nbsp;<I>Promise of no raiding/hiring</I>. The Participant promises and agrees that during the Restricted
Period the Participant will <B>not</B> solicit or attempt to solicit and will <B>not</B> encourage or induce in any way any Participant, joint venturer, or business partner of Middlefield or a Related Entity to terminate an employment or contractual
relationship with Middlefield or the Related Entity. The Participant agrees that the Participant will <B>not</B> hire any person employed by Middlefield or a Related Entity during the <FONT STYLE="white-space:nowrap">two-year</FONT> period before
the Participant&#146;s employment termination with Middlefield or a Related Entity or any person employed by Middlefield or a Related Entity during the Restricted Period. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(c)&nbsp;&nbsp;&nbsp;&nbsp;<I>Promise of no disparagement</I>. The Participant promises and agrees that during the Restricted
Period the Participant will <B>not</B> cause statements to be made (whether written or oral) that reflect negatively on the business reputation of Middlefield or a Related Entity. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(d)&nbsp;&nbsp;&nbsp;&nbsp;<I>Acknowledgment and remedies</I>. The Participant acknowledges and agrees that the provisions of
this section 14 have been negotiated and carefully determined to be reasonable and necessary for the protection of Middlefield&#146;s legitimate business interests. The Participant acknowledges and agrees that a violation of section 14 is likely to
cause immediate and irreparable harm to Middlefield, requiring injunctive relief. If a breach or threatened breach by the Participant of any provision of this Stock Award Agreement occurs, Middlefield and its successors and assigns may without bond
obtain an injunction restraining the Participant from violating the terms of this Stock Award Agreement, and also may institute an action against the Participant to recover damages from the Participant for the breach. These remedies for default or
breach are in addition to any other remedy or form of redress provided under Ohio law. The parties acknowledge that the provisions of this section 14 survive termination of the employment relationship and are enforceable by Middlefield and its
successors and assigns. The parties agree that if any of the provisions of this section 14 are deemed unenforceable by a court of competent jurisdiction, the unenforceable provisions may be stricken as independent clauses by the court in order to
enforce the remaining territory restrictions and that the intent of the parties is to afford the broadest restriction on post-employment activities as set forth in this Stock Award Agreement. If Middlefield initiates legal action to enforce the
provisions of this section 14 or to recover damages for the Participant&#146;s violation of section 14 and if as a result of that legal action the Participant is held to have violated this section 14, the Participant must reimburse Middlefield for
reasonable costs for enforcement of this section 14, including but not limited to attorneys&#146; fees. </P>
<P STYLE="margin-top:18pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(e)&nbsp;&nbsp;&nbsp;&nbsp;<I>Definitions</I>: </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(1)&nbsp;&nbsp;&nbsp;&nbsp;&#147;Restricted Period,&#148; as used herein, means the
<FONT STYLE="white-space:nowrap">12-month</FONT> period immediately after the Participant&#146;s termination and/or separation of employment with Middlefield or a Related Entity, regardless of the reason for termination and/or separation. The
Restricted Period shall be extended in an amount equal to any time period during which a violation of section 14 of this Stock Award Agreement is proven. </P>
<P STYLE="line-height:8.0pt;margin-top:0pt;margin-bottom:2pt;border-bottom:1px solid #000000;width:10%">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="4%" VALIGN="top" ALIGN="left"><SUP STYLE="font-size:85%; vertical-align:top">1</SUP>&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">For example, the promise of no solicitation applies if the Participant is conducting prohibited business in the Restricted Territory <U>or</U> if the entity with, for, or to whom the Participant is conducting prohibited
business is located within the Restricted Territory. </TD></TR></TABLE>
 <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">4 </P>


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 <P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(2)&nbsp;&nbsp;&nbsp;&nbsp;&#147;Restricted Territory,&#148; as used herein,
means all of Geauga, Trumbull, Portage, Ashtabula, and Franklin Counties in Ohio and the area within a <FONT STYLE="white-space:nowrap">25-mile</FONT> radius of any banking office of Middlefield or a Related Entity, if the banking office exists on
the date of the Participant&#146;s employment termination. </P> <P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(3)&nbsp;&nbsp;&nbsp;&nbsp;&#147;Customer,&#148; as used
herein, means any individual, joint venturer, entity of any sort, or other business partner of Middlefield or a Related Entity with, for, or to whom Middlefield or the Related Entity has provided Financial Products or Services during the last two
years of the Participant&#146;s employment with Middlefield or Related Entity, or any individual, joint venturer, entity of any sort, or business partner whom Middlefield or a Related Entity has identified as a prospective customer of Financial
Products or Services within the last two years of the Participant&#146;s employment with Middlefield or Related Entity. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(4)&nbsp;&nbsp;&nbsp;&nbsp;&#147;Financial Products or Services,&#148; as used herein, means any product or service that a
financial institution or a financial holding company could offer by engaging in any activity that is financial in nature or incidental to such a financial activity under section 4(k) of the Bank Holding Company Act of 1956 and that is offered by
Middlefield or a Related Entity on the date of the Participant&#146;s employment termination, including but not limited to banking activities and activities that are closely related and a proper incident to banking, or other products or services of
the type the Participant was involved in during the Participant&#146;s employment with Middlefield or a Related Entity. </P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:4%; text-indent:4%; font-size:10pt; font-family:Times New Roman">(f)&nbsp;&nbsp;&nbsp;&nbsp;<I>Enforcement by successors</I>. The provisions of this section are binding upon and enforceable by
Middlefield and any successor to Middlefield, including any person acquiring directly or indirectly all or substantially all of the business, assets, or stock of Middlefield. The Participant&#146;s consent is not necessary for any assignment or
transfer of the rights and obligations of this section that occurs or is deemed to occur as the result of any person acquiring directly or indirectly all or substantially all of the business, assets, or stock of Middlefield. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B>I<SMALL>N</SMALL> W<SMALL>ITNESS</SMALL> W<SMALL>HEREOF</SMALL></B><SMALL></SMALL>, Middlefield has caused this Stock Award Agreement to be
executed by its duly authorized officer as of the date specified in section 2, and the Participant has duly executed this Stock Award Agreement as of the date specified in section 2 and consents to and approves all of its terms. </P>
<P STYLE="font-size:12pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE CELLSPACING="0" CELLPADDING="0" WIDTH="100%" BORDER="0" STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt">


<TR>
<TD WIDTH="37%"></TD>
<TD VALIGN="bottom" WIDTH="1%"></TD>
<TD WIDTH="14%"></TD>
<TD VALIGN="bottom" WIDTH="1%"></TD>
<TD WIDTH="2%"></TD>
<TD VALIGN="bottom" WIDTH="1%"></TD>
<TD WIDTH="43%"></TD>
<TD VALIGN="bottom" WIDTH="1%"></TD>
<TD></TD></TR>


<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top"><B>P<SMALL>ARTICIPANT</SMALL></B></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom" COLSPAN="3"><B>M<SMALL>IDDLEFIELD</SMALL> B<SMALL>ANC</SMALL> C<SMALL>ORP</SMALL></B><SMALL></SMALL>.<B></B></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom"></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom" COLSPAN="3">an Ohio corporation</TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom"></TD></TR>
<TR STYLE="font-size:1pt">
<TD HEIGHT="16"></TD>
<TD HEIGHT="16" COLSPAN="2"></TD>
<TD HEIGHT="16" COLSPAN="2"></TD>
<TD HEIGHT="16" COLSPAN="2"></TD>
<TD HEIGHT="16" COLSPAN="2"></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top"> <P STYLE="margin-top:0pt; margin-bottom:1pt; border-bottom:1px solid #000000; font-size:10pt; font-family:Times New Roman">&nbsp;</P></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom">By:</TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom"> <P STYLE="margin-top:0pt; margin-bottom:1pt; border-bottom:1px solid #000000; font-size:10pt; font-family:Times New Roman">&nbsp;</P></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom"> <P STYLE="margin-top:0pt; margin-bottom:1pt; border-bottom:1px solid #000000; font-size:10pt; font-family:Times New Roman">&nbsp;</P></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top">Print Name:</TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom" COLSPAN="3">Print Name:</TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom"></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom" COLSPAN="3">Its:</TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="bottom"></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top">Residence Address:</TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD VALIGN="top"></TD>
<TD VALIGN="bottom">&nbsp;</TD>
<TD COLSPAN="5" VALIGN="bottom"></TD></TR>
</TABLE>
 <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">5 </P>

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</TEXT>
</DOCUMENT>
</SEC-DOCUMENT>
