0001768102-19-000001.txt : 20190214 0001768102-19-000001.hdr.sgml : 20190214 20190214151522 ACCESSION NUMBER: 0001768102-19-000001 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181231 FILED AS OF DATE: 20190214 DATE AS OF CHANGE: 20190214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Insurance Capital Group, LLC CENTRAL INDEX KEY: 0001768102 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38718 FILM NUMBER: 19605215 BUSINESS ADDRESS: STREET 1: 767 FIFTH AVENUE, 16TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10153 BUSINESS PHONE: 2123909403 MAIL ADDRESS: STREET 1: 767 FIFTH AVENUE, 16TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10153 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Federal Life Group, Inc. CENTRAL INDEX KEY: 0001743886 STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311] IRS NUMBER: 824944172 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3750 DEERFIELD ROAD CITY: RIVERWOODS STATE: IL ZIP: 60015 BUSINESS PHONE: (847) 520-1900 MAIL ADDRESS: STREET 1: 3750 DEERFIELD ROAD CITY: RIVERWOODS STATE: IL ZIP: 60015 5 1 primary_doc.xml PRIMARY DOCUMENT X0306 5 2018-12-31 0 1 1 0001743886 Federal Life Group, Inc. FLF 0001768102 Insurance Capital Group, LLC 767 FIFTH AVENUE, 16TH FLOOR NEW YORK NY 10153 0 0 1 0 common stock 3 2825500 D common stock 2018-12-18 4 P 0 L 160000 10.5 A 2825500 D common stock 2018-12-19 4 P 0 L 1160000 10.5 A 2825500 D common stock 2018-12-20 4 P 0 L 500 10 A 2825500 D On December 11, 2018, Insurance Capital Group, LLC became a beneficial owner of more than 10% of the issuer's common stock by purchasing 1,505,000 shares of the issuer's common stock pursuant to the issuer's initial public offering. /s/ Matthew T. Popoli, Chief Executive Officer 2019-02-14