Statement of Changes in Beneficial Ownership (4)
December 04 2014 - 11:57AM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Romaine Christopher D
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2. Issuer Name
and
Ticker or Trading Symbol
Fortegra Financial Corp
[
FRF
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
SVP, Gen. Counsel, Secretary
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(Last)
(First)
(Middle)
C/O FORTEGRA FINANCIAL CORPORATION, 10151 DEERWOOD PK BLVD, BLDG 100 STE 330
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3. Date of Earliest Transaction
(MM/DD/YYYY)
12/4/2014
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(Street)
JACKSONVILLE, FL 32256
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock, par value $0.01 per share
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12/4/2014
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D
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12310
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D
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(1)
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0
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Option, Right to Buy 1/1/2013
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$8.89
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12/4/2014
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A
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12338
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(2)
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1/1/2023
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Common Stock
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12338
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$0
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12338
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D
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Option, Right to Buy 1/1/2013
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$8.89
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12/4/2014
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D
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12338
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(2)
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1/1/2023
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Common Stock
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12338
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$1.11
(2)
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0
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D
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Option, Right to Buy 7/1/2011
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$7.84
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12/4/2014
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D
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10000
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(3)
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7/1/2021
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Common Stock
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10000
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$2.16
(3)
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0
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D
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Option, Right to Buy 7/1/2012
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$8.00
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12/4/2014
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D
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15000
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(4)
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7/1/2022
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Common Stock
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15000
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$2.00
(4)
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0
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D
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Option, Right to Buy 9/1/2013
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$7.62
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12/4/2014
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D
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5000
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(5)
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9/1/2023
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Common Stock
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5000
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$2.38
(5)
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0
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D
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Explanation of Responses:
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(
1)
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Shares of Common Stock were disposed of in exchange for the right to receive $10.00 per share in cash pursuant to the Agreement and Plan of Merger by and among Tiptree Operating Company, LLC, Caroline Holdings LLC, Caroline Merger Sub, Inc., and Fortegra Financial Corporation (the "Merger Agreement").
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(
2)
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On January 1, 2013, the reporting person was granted an option to purchase 12,338 shares of Common Stock. These stock options provided for vesting upon the Company's satisfaction of performance goals on or before December 31, 2015 for (i) revenue (Compound Annual Growth Rate), (ii) profitable growth (Net Income) and (iii) earnings (Return on Average Equity). These performance metrics were equally weighted such that achievement of any one target would result in the vesting of one-third of the total equity award. These performance-based stock options were cancelled in exchange for the right to receive the difference between the exercise price of the option and $10.00 per share in cash pursuant to the Merger Agreement. These performance-based stock options vested automatically immediately prior to the consummation of the merger on December 4, 2014, in accordance with the terms of the Merger Agreement.
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(
3)
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These stock options, which are currently exercisable, were cancelled in exchange for the right to receive the difference between the exercise price of the option and $10.00 per share in cash pursuant to the Merger Agreement. These stock options vested automatically immediately prior to the consummation of the merger on December 4, 2014, in accordance with the terms of the Merger Agreement.
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(
4)
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These stock options provided for vesting one-third when the Compensation Committee of the Board determines that the Company has achieved annual Adjusted EBITDA of $46,000,000 and the remainder on each of the two anniversaries of such determination. These stock options were cancelled in exchange for the right to receive the difference between the exercise price of the option and $10.00 per share in cash pursuant to the Merger Agreement. These stock options vested automatically immediately prior to the consummation of the Merger on December 4, 2014, in accordance with the terms of the Merger Agreement.
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(
5)
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These stock options provided for vesting in equal installments on each of the first four anniversaries of the grant date. These stock options were cancelled in exchange for the right to receive the difference between the exercise price of the option and $10.00 per share in cash pursuant to the Merger Agreement. These stock options vested automatically immediately prior to the consummation of the merger on December 4, 2014, in accordance with the terms of the Merger Agreement.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Romaine Christopher D
C/O FORTEGRA FINANCIAL CORPORATION
10151 DEERWOOD PK BLVD, BLDG 100 STE 330
JACKSONVILLE, FL 32256
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SVP, Gen. Counsel, Secretary
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Signatures
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Christopher D. Romaine
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12/4/2014
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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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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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.
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