Amended Annual Statement of Changes in Beneficial Ownership (5/a)
19 Mars 2015 - 6:22PM
Edgar (US Regulatory)
FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
CORRELL JESSE T
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2. Issuer Name
and
Ticker or Trading Symbol
UTG INC [UTG.OB]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Chairman & CEO
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(Last)
(First)
(Middle)
FIRST SOUTHERN BANCORP, P. O. BOX 328
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2014
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(Street)
STANFORD, KY 40484
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
2/12/2015
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Common Stock
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5/1/2014
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G
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2804
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D
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$0
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341997
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I
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By First Southern Funding, LLC
(1)
(2)
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Common Stock
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72750
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I
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By WCorrell Limited Partnership
(3)
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Common Stock
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5/1/2014
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G
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2479
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D
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$0
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204909
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I
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By First Southern Bancorp, Inc.
(4)
(5)
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Common Stock
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1201876
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I
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By First Southern Holding, LLC
(6)
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Common Stock
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32625
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D
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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The reporting person is President and manager of First Southern Funding, LLC. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
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(
2)
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This transaction is being reported to reflect gifts of First Southern Funding, LLC membership interest by the reporting person. On May 1, 2014, the reporting person gifted membership units representing 0.81% of the total outstanding membership units in First Southern Funding, LLC. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
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(
3)
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The reporting person is the managing general partner of WCorrell, Limited Partnership. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
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(
4)
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The reporting person is Chairman and President of First Southern Bancorp, Inc. The reporting person disclaims beneficial ownership of the reported securities except to the extent of this pecuniary interest therein.
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(
5)
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This transaction is being reported to reflect a gift of First Southern Bancorp, Inc. shares by the reporting person. The reporting person gifted 39,809 shares (1.21% of those outstanding) on May 1, 2014. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
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(
6)
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The reporting person is the President and First Southern Bancorp, Inc. is a 99% member of First Southern Holdings, LLC. See notes (3) and (4). The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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CORRELL JESSE T
FIRST SOUTHERN BANCORP
P. O. BOX 328
STANFORD, KY 40484
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X
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X
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Chairman & CEO
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Signatures
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/s/ Jill Martin, Attorney-in-Fact
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3/19/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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