0001140361-17-046610.txt : 20171218 0001140361-17-046610.hdr.sgml : 20171218 20171218201543 ACCESSION NUMBER: 0001140361-17-046610 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171215 FILED AS OF DATE: 20171218 DATE AS OF CHANGE: 20171218 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DORF CARL CENTRAL INDEX KEY: 0001186092 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25001 FILM NUMBER: 171262655 MAIL ADDRESS: STREET 1: 7343 WEST PERSHING AVENUE CITY: PEORIA STATE: AZ ZIP: 85387 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FEDERATED NATIONAL HOLDING CO CENTRAL INDEX KEY: 0001069996 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 650248866 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 14050 NW 14 STREET STREET 2: SUITE 180 CITY: SUNRISE STATE: FL ZIP: 33323 BUSINESS PHONE: 9545819993 MAIL ADDRESS: STREET 1: 14050 NW 14 STREET STREET 2: SUITE 180 CITY: SUNRISE STATE: FL ZIP: 33323 FORMER COMPANY: FORMER CONFORMED NAME: 21ST CENTURY HOLDING CO DATE OF NAME CHANGE: 19980909 4 1 doc1.xml FORM 4 X0306 4 2017-12-15 0 0001069996 FEDERATED NATIONAL HOLDING CO FNHC 0001186092 DORF CARL 14050 N.W. 14 STREET SUITE 180 SUNRISE FL 33323 0 0 0 1 Consultant Common Stock, par value $0.01 per share 2017-12-15 4 S 0 700 14.5128 D 58924 I Held by Carl Dorf Rollover IRA Common Stock, par value $$0.01 per share 27357 D Common Stock, par value $0.01 per share 63491 I Held by Dorf Trust A total of 12,419 of the shares were vested upon the Reporting Person's retirement from the Issuer's Board of Directors on September 19, 2017. /s/ Carl Dorf 2017-12-18