SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 03/28/2017 | 3. Issuer Name and Ticker or Trading Symbol Blue Capital Reinsurance Holdings Ltd. [ BCRH ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Shares | 2,500,000 | I | See Footnote(1) |
Common Shares | 411,518 | I | See Footnote(2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Restricted Share Units | (2) | (2) | Common Shares | 4,704 | 0.0 | I | See Footnote(2) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. Owned by Endurance Specialty Insurance Ltd., an indirect, wholly-owned subsidiary of Sompo Holdings, Inc. and an indirect, wholly-owned subsidiary of Sompo Japan Nipponkoa Insurance, Inc. |
2. Owned by Endurance Specialty Holdings Ltd., an indirect, wholly-owned subsidiary of Sompo Holdings, Inc. and a directly, wholly-owned, subsidiary of Sompo Japan Nipponkoa Insurance, Inc. In accordance with agreements between ESHL and Adam Szakmary and Michael McGuire, respectively, all remuneration, including cash fees, restricted share units, any other equity-based awards and other compensation, to which they are or will become entitled for their service as directors of the company will be assigned or paid directly to ESHL. Mr. Szakmary and Mr. McGuire disclaim beneficial ownership of all such restricted share units. |
Sompo Holdings, Inc., By: /s/ Shigeru Ehara, Representative Director, Senior Managing Executive Officer | 03/30/2017 | |
Sompo Japan Nipponkoa Insurance Inc., By: /s/ Shigeru Ehara, Director, Senior Managing Executive Officer | 03/30/2017 | |
** 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 5 (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. |