15-12B 1 y93267e15v12b.htm FORM 15-12B e15v12b
 
 
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 15
CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION
12(g) OF THE SECURITIES EXCHANGE ACT OF 1934 OR SUSPENSION OF DUTY TO FILE
REPORTS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.
         
 
  Commission File Number   : 1-11983
 
       
FPIC INSURANCE GROUP, INC.
 
(Exact name of registrant as specified in its charter)
1000 Riverside Avenue, Suite 800
Jacksonville, Florida 32204
(904) 354-2482
 
(Address, including zip code, and telephone number, including area code, of registrant’s principal executive offices)
Common stock, par value $0.10 per share
 
(Title of each class of securities covered by this Form)
None
 
(Titles of all other classes of securities for which a duty to file reports under section 13(a) or 15(d) remains)
Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports:
         
Rule 12g-4(a)(1)
  þ    
Rule 12g-4(a)(2)
  o    
Rule 12h-3(b)(1)(i)
  þ    
Rule 12h-3(b)(1)(ii)
  o    
Rule 15d-6
  o    
     
Approximate number of holders of record as of the certification or notice date:
  One
 
   
Pursuant to the requirements of the Securities Exchange Act of 1934, FPIC Insurance Group, Inc., has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.
             
 
          FPIC INSURANCE GROUP, INC.
 
           
Date:
  : October 31, 2011   By:   /s/ Richard E. Anderson, M.D.
 
           
 
          Name: Richard E. Anderson, M.D.
 
          Title: President and Chief Executive Officer
Instruction: This form is required by Rules 12g-4, 12h-3 and 15d-6 of the General Rules and Regulations under the Securities Exchange Act of 1934. The registrant shall file with the Commission three copies of Form 15, one of which shall be manually signed. It may be signed by an officer of the registrant, by counsel or by any other duly authorized person. The name and title of the person signing the form shall be typed or printed under the signature.