0001140361-12-007909.txt : 20120214 0001140361-12-007909.hdr.sgml : 20120214 20120214140215 ACCESSION NUMBER: 0001140361-12-007909 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111231 FILED AS OF DATE: 20120214 DATE AS OF CHANGE: 20120214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CLARK FRED JR CENTRAL INDEX KEY: 0001239490 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18649 FILM NUMBER: 12607533 MAIL ADDRESS: STREET 1: 661 EAST DAVIS CITY: ELBA STATE: AL ZIP: 36323 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NATIONAL SECURITY GROUP INC CENTRAL INDEX KEY: 0000865058 STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311] IRS NUMBER: 631020300 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 661 E DAVIS ST CITY: ELBA STATE: AL ZIP: 36323 BUSINESS PHONE: 2058972273 5 1 doc1.xml FORM 5 X0304 5 2011-12-31 0 0 0 0000865058 NATIONAL SECURITY GROUP INC NSEC 0001239490 CLARK FRED JR 2100 FLOWERS ROAD MATHEWS AL 36052 1 0 0 0 Phantom Stock Units 8.75 2012-02-14 5 J 0 13 8.75 A Phantom Stock Units 13 361 D The phantom stock units were awarded under the nonqualified deferred compensation plan in which directors could elect to defer their directors' fees by receiving phantom stock units payable in cash upon separation from service from the board. The plan was frozen on 12/31/2004. These shares were acquired during the fiscal year pursuant to the dividend reinvestment component of the nonqualified deferred compensation plan which was frozen on 12/31/2004. Pursuant to a plan adopted by the Board in 2010 to terminate the old phantom stock plan, the remaining balance will be distributed in cash during 2012. Pertains to phantom stock plan in which election to defer fees is not a reportable event under Section 16, however acquisitions of phantom stock pursuant to the election are reportable. These deferrals are exempt transactions for purposes of Section 16b-3(d). Brian R. McLeod, Attorney-in-fact 2012-02-14