Document:

Exhibit 4.1

 

	CUSIP NO. ___________	 
	 	 
	COMMON STOCK	COMMON STOCK
	CERTIFICATE NO.	SHARES

 

FEDERAL
LIFE GROUP, INC.

ORGANIZED UNDER THE LAWS OF THE COMMONWEALTH
OF PENNSYLVANIA

 

[SPECIMEN]

 

is the owner of:

 

FULLY PAID AND NONASSESSABLE SHARES OF
COMMON STOCK, 

$0.01 PAR VALUE, OF FEDERAL LIFE GROUP,
INC.

a Pennsylvania corporation.

 

The shares represented by this certificate
are transferable only on the stock transfer books of Federal Life Group, Inc. (the “Company”) by the holder of record
hereof, or by such holder’s duly authorized attorney or legal representative, upon the surrender of this certificate properly
endorsed. This certificate and the shares represented hereby are issued and shall be held subject to all the provisions contained
in the Company’s official corporate papers filed with the Department of State of the Commonwealth of Pennsylvania (copies
of which are on file with the Transfer Agent), to all of the provisions the holder by acceptance hereof assents.

 

This certificate is not valid unless countersigned
and registered by the Transfer Agent and Registrar.

 

IN WITNESS WHEREOF, FEDERAL LIFE GROUP,
INC. has caused this certificate to be executed by the signatures of its duly authorized officers and has caused its corporate
seal to be hereunto affixed.

 

	Dated:	[SEAL]
	 	 
	Treasurer	President and Chief Executive Officer

 

    	 	 	 

     

    

 

FEDERAL LIFE GROUP, INC.

 

Preferred stock may be issued from time
to time as a class without series or, if so determined by the board of directors of the Company, either in whole or in part, in
one or more series. The board of directors of the Company has the authority to fix and determine, by resolution, the voting powers,
full or limited, or no voting power, and such designations, preferences and relative, participating, optional, or other special
rights, if any, and the qualifications, limitations, or restrictions thereof, if any, including specifically, but not limited to,
the dividend rights, conversion rights, redemption rights and liquidation preferences, if any, of any wholly unissued series of
preferred stock (or the entire class of preferred stock if none of such shares have been issued), the number of shares constituting
any such series and the terms and conditions of the issue thereof. The Company will furnish to any shareholder upon request and
without charge a full description of each class of stock and any series thereof.

 

The shares represented by this certificate
may not be cumulatively voted in the election of directors of the Company.

 

    	 	 	 

     

    

 

The following abbreviations, when used in the inscription on
the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations:

 

	TEN COM	-	as tenants in common	UNIF GIFTS MIN ACT -	__________ custodian  __________
	TEN ENT	-	as tenants by the entireties	 	       (Cust)                                (Minor)
    
	JT TEN	-	as joint tenants with right of	 	 
	 	 	survivorship and not as tenants	 	under Uniform Gifts to Minors Act
	 	 	in common	 	 
	 	 	 	 	
	 	 	 	 	(State)

 

Additional abbreviations may also be used
though not in the above list.

 

FOR VALUE RECEIVED, __________
hereby sell, assign and transfer unto

 

PLEASE INSERT SOCIAL SECURITY
OR

OTHER IDENTIFICATION NUMBER
OF ASSIGNEE

 

[                                            ]

	 
	Please print or typewrite name and address
    including postal zip code of assignee.

 

__________________________________________________
shares of the common stock represented by this certificate and do hereby irrevocably constitute and appoint _____________________________________________________________,
attorney, to transfer the said stock on the books of the within-named corporation with full power of substitution in the premises.

 

	DATED  ______________________	
	 	NOTICE:  The signature to this assignment must correspond with the name as
    written upon the face of the certificate in every particular without alteration or enlargement or any change whatever.
	 	
	SIGNATURE GUARANTEED:	 
	 	THE SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION, (BANKS, STOCKBROKERS,
    SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT
    TO S.E.C. RULE 17Ad-15Exhibit
4.2

 

Exchangeable
PROMISSORY NOTE

 

	Up to $2,000,000	June 29,
    2018

 

For
value received Federal Life Mutual Holding Company, an Illinois corporation
(the “Company”), promises to pay to Insurance Capital Group LLC or its assigns (“Holder”)
the principal sum of up to TWO MILLION DOLLARS $2,000,000 (the “Maximum Amount”) together with accrued
and unpaid interest thereon, each due and payable on the date and in the manner set forth below.

 

This
exchangeable promissory note (the “Note”) is issued in connection with that certain Standby Stock Purchase
Agreement (as may be amended, the “Purchase Agreement”) dated as of the date hereof, among the Company,
Federal Life Group, Inc. (“ListCo”), Federal Life Insurance Company (“Federal Life”)
and Holder. Capitalized terms used herein without definition shall have the meanings given to such terms in the Purchase Agreement.

 

1.       Advances.
Advances under this Note (each, an “Advance” and, collectively, the “Advances”)
shall be made within five (5) Business Days of the receipt by Holder of a written request from the Company, which request shall
include the amount of the requested Advance and wire details of the Company’s bank account into which such Advance shall
be paid. The Company may not request an Advance, and Holder shall have no obligation to fund an Advance (a) until Holder has received
evidence satisfactory to it (in its sole and absolute discretion) of the proper filing of the Registration Statement, (b) if an
Event of Default shall have occurred and be continuing, or (c) if the amount requested, when added to the aggregate amount of
all prior Advances, would exceed the Maximum Amount. Nothing herein shall entitle the Company to re-borrow any Advances previously
repaid.

 

2.       Payments
Generally. All payments of interest and principal shall be in lawful money of the United States of America. All payments shall
be applied first to accrued interest, and thereafter to principal.

 

(a)       Payments
of Interest. Unless this Note has been previously exchanged in accordance with the terms of Section 4 below (or as
otherwise agreed by the Company and Holder), commencing September 30, 2018 and continuing until all amounts due under the Note
are paid in full, the Company shall make interest payments in arrears at the rate described in Section 3 hereof on the
last day of each calendar quarter.

 

(b)       Payments
of Principal. Unless this Note has been previously exchanged in accordance with the terms of Section 4 below (or as
otherwise agreed by the Company and Holder), the Company shall repay the outstanding Advances, together with any accrued and unpaid
interest on the earlier to occur of (i) the date that is two (2) years following the date hereof, (ii) the date of the issuance
of Shares in connection with the Community Offering, in which case the outstanding Advances shall be exchanged for Shares in the
manner described in Section 4 on such date and (iii) the date on which payment of this Note is accelerated pursuant to
Section 7 hereof (the “Maturity Date”).

 

(c)       Prepayments.
The Advances may not be prepaid prior to the date of the issuance of Shares in connection with the Community Offering.

 

3.       Interest
Rate. Interest shall accrue on the amount of the outstanding Advances during each calendar quarter following the date of this
Note at a rate for such quarter equal to (a) from the date of this Note to the date that is twelve months (or, if the Outside
Date is extended pursuant to Section 16(a)(iv) of the Purchase Agreement, eighteen months) following the date of this Note, three
and three-quarters percent (3.75%) per annum and (b) thereafter, or anytime after the occurrence and during the continuation of
an Event of Default (defined below), ten percent (10%) per annum. Interest shall be calculated on the basis of a 365-day year
for the actual number of days elapsed.

 

    	 	 	 

     

    

 

4.       Assumption
and Exchange. Upon the occurrence of the Conversion and the issuance of Shares in connection with the Community Offering,
Listco shall automatically assume and be liable for the obligations of the Company hereunder and the outstanding Advances shall
be exchanged and deemed to be repaid in full upon the issuance to Holder of a number of Shares equal to aggregate amount of the
outstanding Advances divided by the Subscription Price.

 

5.       Expenses.
In the event of any default hereunder, the Company shall pay all reasonable attorneys’ fees and court costs incurred by
Holder in enforcing and collecting this Note.

 

6.       Covenants.
Until all of the obligations to pay principal and interest under this note shall have been satisfied (whether by payment or by
exchange in accordance with Section 4), the Company shall not (a) incur or permit to exist any Indebtedness other than
the Indebtedness under this Note, permit Listco to incur or permit to exist any Indebtedness other than the Indebtedness under
this Note, or permit Federal Life to incur or permit to exist any Indebtedness other than Indebtedness that Federal Life is permitted
to incur under the Purchase Agreement (notwithstanding the termination of the Purchase Agreement), (b) declare or pay any dividends
or other distributions to its shareholders, (c) sell or dispose of any of its assets or cause or permit Federal Life to, directly
or indirectly, sell or dispose of any of its assets outside of the ordinary course of Federal Life’s business, or (d) without
the prior written consent of Holder, make any investments or acquisitions of assets or cause or permit Federal Life to make any
investments or acquisitions of assets outside of the ordinary course of its business.

 

7.       Default.
If there shall be any Event of Default hereunder, at the option and upon the declaration of Holder and upon written notice to
the Company (which election and notice shall not be required in the case of an Event of Default under Section 7(c) or Section
7(d)), this Note shall accelerate and all principal and unpaid accrued interest shall become due and payable. For the purposes
of this Note, an “Event of Default” shall mean the occurrence of any one or more of the following:

 

(a)       The
Company fails to pay timely any of the principal amount due under this Note on the date the same becomes due and payable or any
accrued interest or other amounts due under this Note on the date the same becomes due and payable;

 

(b)       The
Company, ListCo or Federal Life shall default in its performance of any covenant under the Purchase Agreement or the Note;

 

(c)       The
Company files any petition or action for relief under any bankruptcy, reorganization, insolvency or moratorium law or any other
law for the relief of, or relating to, debtors, now or hereafter in effect, or makes any assignment for the benefit of creditors
or takes any corporate action in furtherance of any of the foregoing;

 

(d)       An
involuntary petition is filed against the Company (unless such petition is dismissed or discharged within 60 days under any bankruptcy
statute now or hereafter in effect, or a custodian, receiver, trustee, assignee for the benefit of creditors (or other similar
official) is appointed to take possession, custody or control of any property of the Company); or

 

8.       Waiver.
The Company hereby waives: (a) all presentments, demands for performance, notices of nonperformance (except to the extent required
by the provisions of this Note), protests, notices of protest and notices of dishonor; (b) any requirement of diligence or promptness
on the part of Holder in the enforcement of its rights hereunder; (c) any and all notices of every kind and description which
may be required to be given by any statute or rule of law; and (d) any defense (other than indefeasible payment in full) which
it may now or hereafter have with respect to its liability hereunder.

 

    	 	2	 

     

    

 

9.       Governing
Law. This Note shall be governed by and construed under the laws of the State of New York, without giving effect to conflicts
of laws principles which would lead to the application of the laws of any other jurisdiction.

 

10.       Modification;
Waiver. Any term of this Note may be amended or waived with the written consent of the Company and Holder.

 

11.       Assignment.
This Note may be transferred only (i) upon its surrender to the Company for registration of transfer, duly endorsed, or accompanied
by a duly executed written instrument of transfer in form reasonably satisfactory to the Company and (ii) unless the Purchase
Agreement has been terminated in accordance with the terms thereof, in connection with an assignment of Holder’s rights
under the Purchase Agreement in accordance with Section 19 thereof. Thereupon, this Note shall be reissued to, and registered
in the name of, the transferee, or a new Note for like principal amount and interest shall be issued to, and registered in the
name of, the transferee. Interest and principal shall be paid solely to the registered holder of this Note. Such payment shall
constitute full discharge of the Company’s obligation to pay such interest and principal.

 

[Signature
Page Follows]

 

    	 	3	 

     

    

 

IN WITNESS
WHEREOF, the Company and ListCo have caused this Note to be duly executed and delivered as of the date first above written.

 

	 	FEDERAL LIFE MUTUAL HOLDING COMPANY
	 	 	 
	 	By:	 
	 	 	William S. Austin
	 	 	President
	 	 	 
	 	FEDERAL LIFE GROUP, INC.
	 	 	 
	 	By:	 
	 	 	William S. Austin
	 	 	President

 

[Signature Page to Exchangeable Promissory
Note]

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