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