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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1. Name and Address of Reporting Person*
Apex Holdco L.P.

(Last) (First) (Middle)
767 5TH AVE, 23RD FLOOR

(Street)
NEW YORK NY 10153

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/07/2019
3. Issuer Name and Ticker or Trading Symbol
Vericity, Inc. [ VERY ]
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)
Form filed by One Reporting Person
X 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 11,373,352 D
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
1. Name and Address of Reporting Person*
Apex Holdco L.P.

(Last) (First) (Middle)
767 5TH AVE, 23RD FLOOR

(Street)
NEW YORK NY 10153

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Apex Holdco GP LLC

(Last) (First) (Middle)
C/O J.C. FLOWERS & CO. LLC
767 FIFTH AVENUE, 23RD FLOOR

(Street)
NEW YORK NY 10153

(City) (State) (Zip)
1. Name and Address of Reporting Person*
JCF Associates IV L.P.

(Last) (First) (Middle)
C/O J.C. FLOWERS & CO. LLC
767 FIFTH AVENUE, 23RD FLOOR

(Street)
NEW YORK NY 10153

(City) (State) (Zip)
1. Name and Address of Reporting Person*
JCF Associates IV Ltd.

(Last) (First) (Middle)
C/O J.C. FLOWERS & CO. LLC
767 FIFTH AVENUE, 23RD FLOOR

(Street)
NEW YORK NY 10153

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Flowers J. Christopher

(Last) (First) (Middle)
717 FIFTH AVENUE
26TH FLOOR

(Street)
NEW YORK NY 10022

(City) (State) (Zip)
Explanation of Responses:
Apex Holdco L.P. By: /s/Todd Freebern 08/07/2019
Apex Holdco GP LLC By: /s/ Eric Rahe Name: Eric Rahe Title: Vice President 08/07/2019
JCF Associates IV L.P. By: /s/ J. Christopher Flowers Name: J. Christopher Flowers Title: Director 08/07/2019
JCF Associates IV Ltd. By: /s/ J. Christopher Flowers Name: J. Christopher Flowers Title: Director 08/07/2019
/s/ J. Christopher Flowers 08/07/2019
** 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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