0001174947-17-001773.txt : 20171212
0001174947-17-001773.hdr.sgml : 20171212
20171212130258
ACCESSION NUMBER: 0001174947-17-001773
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171211
FILED AS OF DATE: 20171212
DATE AS OF CHANGE: 20171212
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Marlow Stephen V.
CENTRAL INDEX KEY: 0001699509
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37973
FILM NUMBER: 171251357
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
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
formfour.xml
OWNERSHIP DOCUMENT
X0306
4
2017-12-11
0
0001681206
NI Holdings, Inc.
NODK
0001699509
Marlow Stephen V.
1101 FIRST AVENUE NORTH
FARGO
ND
58102
1
0
0
0
Common Stock
2017-12-11
4
A
0
1400
0.00
A
3900
D
These shares are represented by restricted stock units.
Includes restricted stock units.
/s/ Stephen V. Marlow
2017-12-11