SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
| |||||||||||||||
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol TIPTREE INC. [ TIPT ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| ||||||||||||||||||||||||
3. Date of Earliest Transaction (Month/Day/Year) 04/10/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Class A Common Stock | 04/10/2018 | J(1) | 2,462,248(1) | A | (1) | 7,367,756 | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Tiptree Financial Partners, L.P. partnership unit | (2) | 04/10/2018 | J(1) | 880,003 | 07/01/2014 | (2) | Class A Common Stock | 2,462,248 | (1) | 0 | D | ||||
Tiptree Financial Partners, L.P. partnership unit warrant | $7.59 | 04/10/2018 | J(1) | 319,375 | 07/01/2014 | 06/30/2022 | Class A Common Stock | 893,612 | (1) | 0 | D | ||||
Tiptree Inc. warrant 2018 | $11.33 | 04/10/2018 | J(3) | 37,318 | 04/10/2018 | 09/30/2018 | Class A Common Stock | 37,318 | (1) | 37,318 | D | ||||
Tiptree Inc. warrant 2022 | $7.59 | 04/10/2018 | J(1) | 893,612 | 04/10/2018 | 06/30/2022 | Class A Common Stock | 893,612 | (1) | 893,612 | D |
Explanation of Responses: |
1. On 4/10/18, Tiptree Inc. ("Tiptree") merged with its subsidiary, Tiptree Financial Partners, L.P. ("TFP") with Tiptree as the surviving company (the "Merger"). Prior to the Merger, Tiptree owned 84% of TFP with the remainder owned by limited partners, one of whom was Mr. Barnes. In the Merger, each limited partner of TFP received for its TFP units (the "LP Units"), (i) the number of Tiptree Class A common stock ("Tiptree Shares") that they were entitled to exchange into using the existing rate of 2.798 Tiptree Shares per LP Unit (ii) a warrant, expiring 9/30/18, to purchase Tiptree Shares ("2018 Warrant") and (iii) warrants to acquire Tiptree Shares on the same economic terms as their existing warrants to acquire LP Units ("2022 Warrant"). Mr. Barnes received (i) 2,462,248 Tiptree Shares for his 880,003 LP Units; (ii) the 2018 Warrant exercisable to acquire 37,318 Tiptree Shares; and (iii) the 2022 Warrant exercisable to acquire 893,612 Tiptree Shares. |
2. From and after July 1, 2014, the limited partners of TFP have the ability to exchange TFP partnership units for Tiptree Class A common stock at a rate of 2.798 shares of Class A common stock per partnership unit. |
3. In connection with the Reorganization Merger, the original warrant, expiring on September 30, 2018, held by TFP to acquire up to 652,500 Tiptree Shares at an exercise price of $11.33 per share was canceled and converted into the right to receive a pro-rata portion of the 2018 Warrant. Mr. Barnes may acquire 37,318 Tiptree Shares pursuant to the terms of the 2018 Warrant. |
Remarks: |
/s/ Neil C. Rifkind, as Attorney-in-fact for Michael Barnes | 04/12/2018 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |