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Q
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10
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44931
Q
10
4
|
|
|
|
|
1
|
NAMES OF REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
R. Kevin Clinton
|
|
2
|
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (see instructions) (a)
☐
(b)
☐
|
|
3
|
SEC USE ONLY
|
|
4
|
SOURCE OF FUNDS (see instructions)
PF
|
|
5
|
CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e)
☐
|
|
6
|
CITIZENSHIP OR PLACE OF ORGANIZATION
United States
|
|
NUMBER OF
|
7
|
SOLE VOTING POWER
76,459
|
|
SHARES BENEFICALLY
|
8
|
SHARED VOTING POWER
0
|
|
OWNED BY
EACH
|
9
|
SOLE DISPOSITIVE POWER
76,459
|
|
REPORTING
PERSON
WITH
|
10
|
SHARED DISPOSITIVE POWER
0
|
|
11
|
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
76,459
|
|
12
|
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (see instructions)
☐
|
|
13
|
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
2.2
%
|
|
14
|
TYPE OF REPORTING PERSON (see instructions)
IN
|
C
U
S
I
P
N
o
.
44931
Q
10
4
|
|
|
|
|
1
|
NAMES OF REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Marilyn J. Clinton
|
|
2
|
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (see instructions) (a)
☐
(b)
☐
|
|
3
|
SEC USE ONLY
|
|
4
|
SOURCE OF FUNDS (see instructions)
PF
|
|
5
|
CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e)
☐
|
|
6
|
CITIZENSHIP OR PLACE OF ORGANIZATION
United States
|
|
NUMBER OF
|
7
|
SOLE VOTING POWER
376,000
|
|
SHARES BENEFICALLY
|
8
|
SHARED VOTING POWER
0
|
|
OWNED BY
EACH
|
9
|
SOLE DISPOSITIVE POWER
376,000
|
|
REPORTING
PERSON
WITH
|
10
|
SHARED DISPOSITIVE POWER
0
|
|
11
|
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
376,000
|
|
12
|
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (see instructions)
☐
|
|
13
|
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
10.7
%
|
|
14
|
TYPE OF REPORTING PERSON (see instructions)
IN
|
C
U
S
I
P
N
o
.
44931
Q
10
4
The Reporting Persons are filing this Amendment No. 1 to the Schedule 13D (“Amendment No. 1”) to amend and supplement the original Schedule 13D filed on April 17, 2017 (the “13D Filing”). The purpose of this Amendment No. 1 is to expand and supplement the Reporting Persons’ disclosures under Items 3, 5 and 7 to reflect the sale of shares of common stock on September 7, 2018 pursuant to a stock purchase agreement, dated August 31, 2018 (the “Stock Purchase Agreement”), with ICC Holdings, Inc. Capitalized terms used and not defined in this Amendment No. 1 have the meanings ascribed to such terms in the 13D Filing. Except as specifically amended and supplemented by this Amendment No. 1, the 13D Filing remains in full force and effect.
I
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.
Item 3 is hereby amended to add the following paragraph:
The Reporting Persons sold 147,541 shares of Common Stock to the Issuer for an aggregate purchase price of $2,250,000.25 ($15.25 per share) pursuant to the Stock Purchase Agreement. As of the date hereof, the Reporting Persons hold 452,459 shares of Common Stock.
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(
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Joint Filing Agreement
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Purchase Agreement dated September 7, 2016,
incorporated by reference to the Issuer’s Form S-1 filed on October 13, 2016,
as amended (SEC File No. 333-214081).
Exhibit 3
Stock Purchase Agreement, dated August 31, 2018, by and between ICC Holdings, Inc. and certain entities and individuals identified on Annex A thereto.
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/s/ R. Kevin Clinton
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R. Kevin Clinton
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Date: September
1
2
, 2018
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Exhibit 1
Joint Filing Agreement
The undersigned hereby agree that the statements on Amendment No. 1 to the Schedule 13D, dated as of the date hereof (the “Statement”), with respect to the Common Stock, par value $0.01 per share, of ICC Holdings, Inc., a Pennsylvania corporation, is, and any amendments thereto executed by each of us shall be, filed on behalf of each of us pursuant to and in accordance with the provisions of Rule 13d-1(k)(1) under the Securities Exchange Act of 1934, as amended, and that this Joint Filing Agreement shall be included as an exhibit to the Statement and each such amendment. Each of the undersigned agrees to be responsible for the timely filing of the Schedule 13D and any amendments thereto, and for the completeness and accuracy of the information concerning itself contained therein. This Joint Filing Agreement may be executed in any number of counterparts, all of which taken together shall constitute one and the same instrument.
IN WITNESS WHEREOF, the undersigned have executed this Joint Filing Agreement as of
the 12
th day of September, 2018.
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/s/ R. Kevin Clinton
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/s/ Marilyn J. Clinton
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R. Kevin Clinton
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Marilyn J. Clinton
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