0001567619-21-003886.txt : 20210216
0001567619-21-003886.hdr.sgml : 20210216
20210216132123
ACCESSION NUMBER: 0001567619-21-003886
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201231
FILED AS OF DATE: 20210216
DATE AS OF CHANGE: 20210216
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CLARK FRED JR
CENTRAL INDEX KEY: 0001239490
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-18649
FILM NUMBER: 21635481
MAIL ADDRESS:
STREET 1: 661 EAST DAVIS
CITY: ELBA
STATE: AL
ZIP: 36323
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: NATIONAL SECURITY GROUP INC
CENTRAL INDEX KEY: 0000865058
STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311]
IRS NUMBER: 631020300
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 661 E DAVIS ST
CITY: ELBA
STATE: AL
ZIP: 36323
BUSINESS PHONE: 2058972273
5
1
doc1.xml
FORM 5
X0306
5
2020-12-31
0
0
0
0000865058
NATIONAL SECURITY GROUP INC
NSEC
0001239490
CLARK FRED JR
2100 FLOWERS ROAD
MATHEWS
AL
36052
1
0
0
0
Common Stock
78707
D
Common Stock
22618
I
By Children
Corrects total of indirect shares reported on 10/6/2020 Form 4.
Brian R. McLeod, Attorney-in-fact
2021-02-16