SEC FORM
3
SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
1195 RIVER ROAD |
P O BOX 302 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 04/19/2018
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3. Issuer Name and Ticker or Trading Symbol
DONEGAL GROUP INC
[ DGICA ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Senior Vice President |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Class A Common Stock |
3,337 |
D |
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Class A Common Stock |
21,994 |
I |
401(k) Plan |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Options |
07/01/2013 |
12/20/2022 |
Class A Common Stock |
30,000 |
14.5 |
D |
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Options |
07/01/2014 |
12/19/2023 |
Class A Common Stock |
50,000 |
15.9 |
D |
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Options |
07/01/2015 |
12/18/2024 |
Class A Common Stock |
35,000 |
15.8 |
D |
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Options |
07/01/2016 |
12/17/2020 |
Class A Common Stock |
35,000 |
13.64 |
D |
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Options |
07/01/2017 |
12/15/2021 |
Class A Common Stock |
30,000 |
16.48 |
D |
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Options |
07/01/2018 |
12/21/2022 |
Class A Common Stock |
15,000 |
17.6 |
D |
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Explanation of Responses: |
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Jeffrey D. Miller, by power of attorney |
04/24/2018 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
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 Number. |
CONFIRMING STATEMENT
This Statement confirms that the undersigned, Richard G. Kelley, has authorized
and designated Jeffrey D. Miller and Sheri O. Smith, signing singly, to execute
and file on the undersigned's behalf all Forms 3, 4 and 5 (including any
amendments thereto) that the undersigned may be required to file with the U.S.
Securities and Exchange Commission as a result of the undersigned's ownership
of or transactions in securities of Donegal Group Inc. The authority of each
of the attorneys-in-fact under this Statement shall continue until the
undersigned is no longer required to file Forms 3, 4 and 5 with regard to the
undersigned's ownership of or transactions in securities of Donegal Group Inc.,
unless earlier revoked in writing. The undersigned acknowledges that none of
the aforementioned attorneys-in-fact is assuming any of the undersigned's
responsibilities to comply with Section 16 of the Securities Exchange Act of
1934.
April 19, 2018
Richard G. Kelley