Statement of Changes in Beneficial Ownership (4)
13 April 2021 - 5:51PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
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CABILLOT RAYMOND E |
2. Issuer Name and Ticker or Trading Symbol
OXBRIDGE RE HOLDINGS Ltd
[
OXBR
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O OXBRIDGE RE HOLDINGS LIMITED, 103 S. CHURCH ST., P.O. BOX 469 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/2/2021 |
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(Street)
GRAND CAYMAN, E9 KY1-9006
(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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| Ordinary Shares, Par Value $0.001 | | | | | | | | 7225 | I | See footnote (1) (1) |
| Ordinary Shares, Par Value $0.001 | | | | | | | | 47045 | I | See footnote (2) (2) |
| Ordinary Shares, Par Value $0.001 | | | | | | | | 35000 | D | |
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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
| Share Options (right to buy) | $6.00 | 3/2/2021 | | A (3) | | 50000 | | (4) | 3/2/2031 | Ordinary Shares | 50000 | $0 | 50000 | D | |
| Explanation of Responses: |
| (1) | Shares indirectly held in the name of Farnam Street Capital for the benefit of and as the General Partner of FS Special Opportunities I Fund. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for the purposes of Section 16 or for any other purpose, except to the extent of the reporting person's pecuniary interest in such securities. |
| (2) | Shares indirectly held in the name of Farnam Street Capital for the benefit of and as the General Partner of Farnam Street Partners. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of the reporting person's pecuniary interest in such securities. |
| (3) | This option grant was previously reported on a Form 8-K filed by the issuer on March 8, 2021. |
| (4) | These share options vest in increments of 6.25% each on a quarterly basis, commencing on the date granted, and continuing on April 1st, July 1st, October 1st and January 1st of each calendar year, over a four-year period. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
CABILLOT RAYMOND E
C/O OXBRIDGE RE HOLDINGS LIMITED
103 S. CHURCH ST., P.O. BOX 469
GRAND CAYMAN, E9 KY1-9006 | X |
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Signatures
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| /s/ Raymond E. Cabillot | | 4/12/2021 |
| **Signature of Reporting Person | Date |
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