-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, P+C562Z+dC9p55nN27+Jvv6I6EAuXm0g3spDXhwq4oZ1gmAsDUtOUYQvshJkjUIP dEE8Zmv0Dv2uc4uIuw2mxQ== 0001104659-04-012504.txt : 20040504 0001104659-04-012504.hdr.sgml : 20040504 20040504200909 ACCESSION NUMBER: 0001104659-04-012504 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040430 FILED AS OF DATE: 20040504 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Harrison Thomas Marshall Jr CENTRAL INDEX KEY: 0001289186 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12117 FILM NUMBER: 04779329 BUSINESS ADDRESS: BUSINESS PHONE: 615-844-2901 MAIL ADDRESS: STREET 1: 3813 GREEN HILLS VILLAGE DRIVE CITY: NASHVILLE STATE: TN ZIP: 37215 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: LIBERTE INVESTORS INC CENTRAL INDEX KEY: 0001017907 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 751328153 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 200 CRESCENT COURT STREET 2: SUITE 1365 CITY: DALLAS STATE: TX ZIP: 75201 BUSINESS PHONE: 2148715935 MAIL ADDRESS: STREET 1: 200 CRESCENT COURT STREET 2: SUITE 1365 CITY: DALLAS STATE: TX ZIP: 75201 4 1 a4.xml 4 X0202 4 2004-04-30 0 0001017907 LIBERTE INVESTORS INC FAC 0001289186 Harrison Thomas Marshall Jr 3813 GREEN HILLS VILLAGE DRIVE NASHVILLE TN 37215 1 1 1 0 Exec. VP & Secretary Common Stock 2004-04-30 4 A 0 6624999 A 6624999 D Nonqualified Stock Option (right to buy) 6.64 2004-04-30 4 A 0 100000 0 A 2014-04-29 Common Stock 100000 100000 D Received in exchange for 18,750 shares of USAuto Holdings, Inc. common stock in connection with the merger of USAuto Holdings, Inc. into USAH Merger Sub, Inc., a wholly owned subsidiary of First Acceptance Corporation (f/k/a Libert? Investors Inc.). Exchange ratio was determined by negotiation between the parties. First Acceptance Corporation common stock had a value of $6.55 per share on the date of the merger. The reporting person may receive up to 375,000 additional shares of First Acceptance Corporation common stock pursuant to the merger if certain performance targets relating to First Acceptance Corporation's business are achieved. The option vests 20% on April 30, 2005 and 1-2/3% on the last day of each month thereafter. /s/ Thomas M. Harrison, Jr. 2004-05-04 -----END PRIVACY-ENHANCED MESSAGE-----