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) 10/28/2019 | 3. Issuer Name and Ticker or Trading Symbol BRP Group, Inc. [ BRP ] | |||||||||||||
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) |
Class B Common Stock | 18,933,907(1)(2) | D | |
Class B Common Stock | 2,481,998(1)(3) | D | |
Class B Common Stock | 608,878(1)(3) | I | By Trust |
Class B Common Stock | 304,439(1)(4) | D | |
Class B Common Stock | 304,439(1)(5) | D | |
Class B Common Stock | 2,862,542(1)(6) | D | |
Class B Common Stock | 228,333(1)(6) | I | By Trust |
Class B Common Stock | 152,220(1)(7) | D | |
Class B Common Stock | 76,113(1)(8) | D | |
Class B Common Stock | 495,677(1)(9) | D | |
Class B Common Stock | 190,326(1)(10) | D | |
Class B Common Stock | 337,852(1)(11) | D |
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 | ||||
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 18,933,907(1)(2)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 2,481,998(1)(3)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 608,878(1)(3)(12) | 0 | I | By Trust |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 304,439(1)(4)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 304,439(1)(5)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 2,862,542(1)(6)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 228,333(1)(6)(12) | 0 | I | By Trust |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 152,220(1)(7)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 76,113(1)(8)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 495,677(1)(9)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 190,326(1)(10)(12) | 0 | D | |
LLC Units in Baldwin Risk Partners, LLC | (12) | (12) | Class A Common Stock | 337,852(1)(11)(12) | 0 | D |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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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. This excludes securities owned by the Villages Invesco, LLC (the "Villages") relating to a voting agreement between the Villages and members of the "group" referenced in footnote 2, for which the reporting persons disclaim beneficial ownership. |
2. These securities are owned by Baldwin Insurance Group Holdings, LLC ("BIGH"), which is a member of a "group" pursuant to a voting agreement with (and with respect to the securities owned by) those individuals listed in the "Remarks" section (the "Voting Group"). These securities were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by BIGH in Baldwin Risk Partners, LLC ("Baldwin Risk Partners"). |
3. These securities are owned by Elizabeth Krystyn and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by Elizabeth Krystyn in Baldwin Risk Partners. |
4. These securities are owned by Elizabeth H. Krystyn 2019 Grantor Retained Annuity Trust I Dated September 30, 2019 and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by Elizabeth H. Krystyn 2019 Grantor Retained Annuity Trust I Dated September 30, 2019 in Baldwin Risk Partners. |
5. These securities are owned by Elizabeth H. Krystyn 2019 Grantor Retained Annuity Trust II Dated September 30, 2019 and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by Elizabeth H. Krystyn 2019 Grantor Retained Annuity Trust II Dated September 30, 2019 in Baldwin Risk Partners. |
6. These securities are owned by Laura Sherman and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by Laura Sherman in Baldwin Risk Partners. |
7. These securities are owned by Laura R. Sherman GRAT 2019-1 Dated September 30, 2019 and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by Laura R. Sherman GRAT 2019-1 Dated September 30, 2019 in Baldwin Risk Partners. |
8. These securities are owned by Laura R. Sherman GRAT 2019-2 Dated September 30, 2019 and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by Laura R. Sherman GRAT 2019-2 Dated September 30, 2019 in Baldwin Risk Partners. |
9. These securities are owned by Kristopher A. Wiebeck 2019 Grantor Retained Annuity Trust Dated September 30, 2019 and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by Kristopher A. Wiebeck 2019 Grantor Retained Annuity Trust Dated September 30, 2019 in Baldwin Risk Partners. |
10. These securities are owned by John A. Valentine 2019 Grantor Retained Annuity Trust Dated September 30, 2019 and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by John A. Valentine 2019 Grantor Retained Annuity Trust Dated September 30, 2019 in Baldwin Risk Partners. |
11. These securities are owned by Joseph D. Finney and were acquired through the conversion immediately prior to the issuer's initial public offering of historical interests held by Joseph D. Finney in Baldwin Risk Partners. |
12. Each LLC Unit, together with a share of Class B common stock, may be converted by the holder into one share of Class A common stock at any time. The LLC Units do not expire. |
Remarks: |
The Voting Group consists of BIGH, Lowry Baldwin, Trevor Baldwin, Elizabeth Krystyn, Elizabeth H. Krystyn 2019 Grantor Retained Annuity Trust I Dated September 30, 2019, Elizabeth H. Krystyn 2019 Grantor Retained Annuity Trust II Dated September 30, 2019, Laura Sherman, Laura R. Sherman GRAT 2019-1 Dated September 30, 2019, Laura R. Sherman GRAT 2019-2 Dated September 30, 2019, Kristopher Aaron Wiebeck, Kristopher A. Wiebeck 2019 Grantor Retained Annuity Trust Dated September 30, 2019, John A Valentine, John A. Valentine 2019 Grantor Retained Annuity Trust Dated September 30, 2019, Daniel Galbraith, Bradford Hale, Joseph D. Finney, Christopher J. Stephens, Millennial Specialty Holdco, LLC and James Morgan Roche for purposes of Section 13(d) of the Securities Exchange Act of 1934. As the Voting Group contains more than ten insiders, see the Form 3 for Millennial Specialty Holdco, LLC filed October 28, 2019 for the securities owned by additional members of the Voting Group. |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Baldwin Insurance Group Holdings, LLC | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Elizabeth Krystyn | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Elizabeth H. Krystyn 2019 Grantor Retained Annuity Trust I Dated September 30, 2019 | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Elizabeth H. Krystyn 2019 Grantor Retained Annuity Trust II Dated September 30, 2019 | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Laura Sherman | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Laura R. Sherman GRAT 2019-1 Dated September 30, 2019 | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Laura R. Sherman GRAT 2019-2 Dated September 30, 2019 | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Kristopher A. Wiebeck 2019 Grantor Retained Annuity Trust Dated September 30, 2019 | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for John A. Valentine 2019 Grantor Retained Annuity Trust Dated September 30, 2019 | 10/28/2019 | |
/s/ Christopher J. Stephens, as Attorney-in Fact, for Joseph D. Finney | 10/28/2019 | |
** 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. |