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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Warrants to Purchase Ordinary Shares | $ 7.5 | 04/09/2014 | P | 4,752 (3) | (4) | 03/31/2019 | Ordinary Shares | 4,752 (3) | (5) | 22,192 | I | See Footnote (2) | |||
Warrants to Purchase Ordinary Shares | $ 7.5 | 04/10/2014 | P | 4,752 (3) | (4) | 03/31/2019 | Ordinary Shares | 4,752 (3) | (5) | 26,944 | I | See Footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
CABILLOT RAYMOND E C/O OXBRIDGE RE HOLDINGS LIMITED 103 S. CHURCH ST., P.O. BOX 469 GRAND CAYMAN, E9 KY1-9006 |
X |
/s/ Curt P. Creely, Attorney-in-Fact for Raymond E. Cabillot | 04/16/2014 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | The number of securities acquired reported in Column 4 of the original Form 4 filed on April 11, 2014 was misstated. The correct number is as set forth in Column 4 of this Amendment. |
(2) | Shares indirectly held in the name of Farnam Street Capital for the benefit of and as the General Partner of FS Special Opportunities I Fund. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of the reporting person's pecuniary interest in such securities. |
(3) | The number of derivative securities acquired reported in Column 5 and the number of shares reported in Column 7 of the original Form 4 filed on April 11, 2014 were misstated. The correct numbers are as set forth in Column 5 and Column 7 of this Amendment. |
(4) | Immediately exercisable. |
(5) | Purchased as part of Units consisting of one Ordinary Share and one Warrant to Purchase one Ordinary Share per Unit. |