Marilyn J. Clinton Form 3 ICC / Marilyn J. Clinton ownership change

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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1. Name and Address of Reporting Person^*

Clinton Marilyn J.

(Last) (First) (Middle)

6410 OAKENCLIFFE LANE

(Street)

EAST LANSING MI 48823

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
03/28/2017

3. Issuer Name and Ticker or Trading Symbol
ICC Holdings, Inc. [ ICCH ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	10% Owner
Officer (give title below)		Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	150,000	I	Held as Trustee under Marilyn J. Clinton Trust Agreement dated August 29, 2001
Common Stock	75,000	I	Held as Trustee for R. Kevin Clinton Irrevocable Trust for Avery Anne Clinton
Common Stock	75,000	I	Held as Trustee for R. Kevin Clinton Irrevocable Trust for Connor Richard Clinton
Common Stock	75,000	I	Held as Trustee for R. Kevin Clinton Irrevocable Trust for Colleen Casey Clinton
Common Stock	75,000	I	Held as Trustee for R. Kevin Clinton Irrevocable Trust for Ryan Kevin Clinton
Common Stock	150,000	I	Held by spouse

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares

Explanation of Responses:

Remarks:

	/s/Marilyn J. Clinton	04/17/2017
	** 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.
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