Statement of Changes in Beneficial Ownership (4)
28 May 2021 - 7:25AM
Edgar (US Regulatory)
FORM 4
[X]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
*
IOWA FARM BUREAU FEDERATION |
2. Issuer Name and Ticker or Trading Symbol
FBL FINANCIAL GROUP INC
[
FFG
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
5400 UNIVERSITY AVENUE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/25/2021 |
(Street)
WEST DES MOINE, IA 50266-5997
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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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Code
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V
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Amount
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(A) or (D)
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Price
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Class A Common Stock | 5/25/2021 | | J | | 14760303 | D | $0 (1) | 0 | D | |
Class B Common Stock | 5/25/2021 | | J | | 7619 | D | $0 (1) | 0 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | On May 25, 2021, the Reporting Person contributed 14,760,303 shares of Class A Common Stock of the Issuer and 7,619 share of Class B Common Stock of the Issuer to 5400 Merger Sub, Inc. ("Merger Sub") in connection with the consummation of the previously-disclosed merger of Merger Sub with and into the Issuer (the "Merger"). Such contribution was thereafter exchanged for an equal number of shares of the common equity in the surviving corporation such that, following the consummation of the Merger, the Reporting Person's common equity ownership of the surviving corporation remains unchanged from its ownership of the Issuer. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
IOWA FARM BUREAU FEDERATION 5400 UNIVERSITY AVENUE WEST DES MOINE, IA 50266-5997 |
| X |
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Signatures
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By: Edward G. Parker per filed confirming statement for: Iowa Farm Bureau Federation | | 5/27/2021 |
**Signature of Reporting Person | Date |
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