0001104659-23-064406.txt : 20230525
0001104659-23-064406.hdr.sgml : 20230525
20230525090156
ACCESSION NUMBER: 0001104659-23-064406
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230524
FILED AS OF DATE: 20230525
DATE AS OF CHANGE: 20230525
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Missling Jeffrey R.
CENTRAL INDEX KEY: 0001699863
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37973
FILM NUMBER: 23956542
MAIL ADDRESS:
STREET 1: 1101 FIRST AVENUE NORTH
CITY: FARGO
STATE: ND
ZIP: 58102
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: NI Holdings, Inc.
CENTRAL INDEX KEY: 0001681206
STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331]
IRS NUMBER: 812683619
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1101 FIRST AVENUE NORTH
CITY: FARGO
STATE: ND
ZIP: 58102
BUSINESS PHONE: 701-298-4200
MAIL ADDRESS:
STREET 1: 1101 FIRST AVENUE NORTH
CITY: FARGO
STATE: ND
ZIP: 58102
4
1
tm2316922-8_4seq1.xml
OWNERSHIP DOCUMENT
X0407
4
2023-05-24
0
0001681206
NI Holdings, Inc.
NODK
0001699863
Missling Jeffrey R.
1101 FIRST AVENUE NORTH
FARGO
ND
58102
1
0
0
0
0
Common Stock
2023-05-24
4
A
0
3800
0.00
A
20400
D
These shares are represented by restricted stock units.
Includes restricted stock units.
These shares include 1,500 restricted stock units that will be deferred issuance until after separation from service.
/s/ Timothy J. Milius
2023-05-25