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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Capital Z Partners III GP, Ltd. 142 WEST 57TH STREET NEW YORK, NY 10019 |
See Remarks Section | |||
Capital Z Partners III, L.P. 230 PARK AVENUE SOUTH 11TH FLOOR NEW YORK, NY 10003 |
See Remarks Section | |||
Capital Z Partners III GP, L.P. 230 PARK AVENUE SOUTH 11TH FLOOR NEW YORK, NY 10003 |
See Remarks Section | |||
CAPITAL Z FINANCIAL SERVICES FUND II LP ONE CHASE MANHATTAN PLAZA NEW YORK, NY 10005 |
See Remarks Section | |||
CAPITAL Z PARTNERS LP ONE CHASE MANHATTAN PLAZA NEW YORK, NY 10005 |
See Remarks Section | |||
CAPITAL Z PARTNERS LTD ONE CHASE MANHATTAN PLAZA NEW YORK, NY 10005 |
See Remarks Section | |||
Capital Z Partners Management, LLC 230 PARK AVENUE 11TH FLOOR NEW YORK, NY 10003 |
See Remarks Section | |||
CAPITAL Z FINANCIAL SERVICES PRIVATE FUND II, L.P. 54 THOMPSON ST. NEW YORK, NY 10012 |
See Remarks Section | |||
Capital Z Management, LLC 142 WEST 57TH STREET 3RD FLOOR NEW YORK, NY 10019 |
See Footnote (1) |
/s/ Craig Fisher, Authorized Signatory for Capital Z Partners III GP, Ltd. | 02/15/2013 | |
**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) | Due to the limitation on the amount of characters used, please see Item 1 of Exhibit 99.2 Explanation of Response. |
(2) | Due to the limitation on the amount of characters used, please see Item 2 of Exhibit 99.2 Explanation of Response. |
(3) | The shareholders of Capital Z Ltd and CZPM, including Bradley Cooper, are officers and co-owners of CZM. Mr. Cooper is also a director of the Issuer. |
(4) | CZM transferred to its owners on a pro rata basis the shares for no consideration on the Transaction Date, including 3,315 shares to Mr. Cooper. |