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 |
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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)
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2. Issuer Name and Ticker or Trading Symbol
MONTPELIER RE HOLDINGS LTD [ MRH ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 06/15/2012 | ||||||||||||||||||||||||||
4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 | ||||||
Restricted Share Units(1) | 06/15/2012 | A | 6,000 | A | $0 | 5,756,000(3)(4)(5) | I | See Footnotes(3)(4)(5) | ||
Restricted Share Units(2) | 06/15/2012 | A | 2,000 | A | $0 | 5,758,000(3)(4)(5) | I | See Footnotes(3)(4)(5) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. These restricted share units vest ratably in equal tranches over a three-year period, beginning on June 15, 2013, assuming continuous service as a director and are payable only in Common Shares or in Common Shares net of applicable tax withholdings. |
2. These restricted share units vest in full on June 15, 2013 assuming on continuous service as a director and are payable only in Common Shares or in Common Shares net of applicable tax withholdings. |
3. The common shares to be issued pursuant to the restricted share units (the "Shares") will be issued to Charlesbank Equity Fund VII, Limited Partnership ("CB VII"), CB Offshore Equity Fund VII, L.P. ("CB Offshore"), CB Parallel Fund VII, Limited Partnership ("CB Parallel"), Charlesbank Equity Coinvestment Fund VII, Limited Partnership ("CB Coinvest VII"), and Charlesbank Coinvestment Partners, Limited Partnership ("CB Coinvest" and, together with CB VII, CB Offshore, CB Parallel, and CB Coinvest VII, the "Funds"), which are investment funds affiliated with Charlesbank Capital Partners, LLC ("Charlesbank"), pursuant to a contractual obligation of Michael R. Eisenson to assign any fees received for service as a director. Mr. Eisenson is a Managing Director and Chief Executive Officer of Charlesbank and serves as the representative of the Charlesbank Entities (as defined below) on the Issuer's board of directors. (Continued in footnote 4) |
4. (Continued from footnote 3) Charlesbank is the investment manager for each of the Funds and is the general partner of Charlesbank Equity Fund VII GP, Limited Partnership ("CB VII GP") and CB Coinvest. CB VII GP is the general partner of CB VII, CB Parallel and CB Coinvest VII and the sole member of CB Offshore Equity Fund VII GP, LLC ("CB Offshore GP" and, together with the Funds, Charlesbank and CB VII GP, the "Charlesbank Entities"), which is the general partner of CB Offshore. CB VII GP disclaims beneficial ownership of the Shares, except to the extent of its pecuniary interest, if any, in the Shares by virtue of its general partner interest in CB VII, CB Parallel and CB Coinvest VII and its membership interest in CB Offshore GP. CB Offshore GP disclaims beneficial ownership of the Shares, except to the extent of its pecuniary interest, if any, in the Shares by virtue of its general partner interest in CB Offshore. (Continued in footnote 5) |
5. (Continued from footnote 4) Charlesbank disclaims beneficial ownership of the Shares, except to the extent of its pecuniary interest, if any, in the Shares by virtue of its general partner interest in CB VII GP and CB Coinvest. |
Charlesbank Equity Fund VII, Limited Partnership, /s/ Tami E. Nason, attorney-in-fact | 06/15/2012 | |
CB Offshore Equity Fund VII, L.P., /s/ Tami E. Nason, attorney-in-fact | 06/15/2012 | |
CB Parallel Fund VII, Limited Partnership, /s/ Tami E. Nason, attorney-in-fact | 06/15/2012 | |
Charlesbank Equity Coinvestment Fund VII, Limited Partnership, /s/ Tami E. Nason, attorney-in-fact | 06/15/2012 | |
Charlesbank Coinvestment Partners, Limited Partnership, /s/ Tami E. Nason, attorney-in-fact | 06/15/2012 | |
Charlesbank Capital Partners, LLC, /s/ Tami E. Nason, attorney-in-fact | 06/15/2012 | |
Charlesbank Equity Fund VII GP, Limited Partnership, /s/ Tami E. Nason, attorney-in-fact | 06/15/2012 | |
CB Offshore Equity Fund VII GP, LLC, /s/ Tami E. Nason, attorney-in-fact | 06/15/2012 | |
** 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. |