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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 | ||||||||
Option (right to buy) (2) | $ 8 | 06/14/2016 | D(1) | 66,066 (2) | 03/31/2014 | 06/15/2016 | Common Stock | 66,066 (2) | (1) | 0 | D | ||||
Option (right to buy) (2) | $ 8 | 06/14/2016 | A(1) | 66,066 (2) | 03/31/2014 | 12/31/2016 | Common Stock | 66,066 (2) | (1) | 66,066 (2) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Raucy Douglas N 1347 PROPERTY INSURANCE HOLDINGS, INC. 1511 NORTH WESTSHORE BLVD, SUITE 870 TAMPA, FL 33607 |
X | President and CEO |
/s/ Beverly Schafman, Attorney-in-Fact | 06/16/2016 | |
**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 reported transactions involved an amendment of an outstanding option, resulting in a deemed cancellation of the "old" option and the grant of a replacement option. |
(2) | Upon exercise of the option to purchase, 33,033 shares of common stock for $8.00 per share, the Reporting Person is entitled to receive an award of 33,033 additional shares of restricted common stock within 30 days. |