0001567619-20-003535.txt : 20200214 0001567619-20-003535.hdr.sgml : 20200214 20200214095133 ACCESSION NUMBER: 0001567619-20-003535 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191231 FILED AS OF DATE: 20200214 DATE AS OF CHANGE: 20200214 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: 20614843 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 X0306 5 2019-12-31 0 0 0 0000865058 NATIONAL SECURITY GROUP INC NSEC 0001239490 CLARK FRED JR 2100 FLOWERS ROAD MATHEWS AL 36052 1 0 0 0 Common Stock 2020-01-06 5 G 0 2000 D 78105 D Common Stock 2020-01-06 5 G 0 2000 D 76105 D Common Stock 2020-01-06 5 G 0 2000 A 20618 I By Children Common Stock 2020-01-06 5 G 0 2000 A 22618. I By Children Shares were disposed of via bona fide gift. Shares were acquired via bona fide gift. Brian R. McLeod, Attorney-in-fact 2020-02-14