-----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, J4L1ZOkLpgvbNSglioOXSFf7Wr9YhmdkB9RHu8nOo4oYSyVNgemuEhN4BfRrVd8j 7+iP0h6Kyn8VNeoEDZin7g== 0001209191-04-027603.txt : 20040524 0001209191-04-027603.hdr.sgml : 20040524 20040524181337 ACCESSION NUMBER: 0001209191-04-027603 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040521 FILED AS OF DATE: 20040524 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FIRST ACCEPTANCE CORP /DE/ 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: 3813 GREEN HILLS VILLAGE DRIVE CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 615-844-2800 MAIL ADDRESS: STREET 1: 3813 GREEN HILLS VILLAGE DRIVE CITY: NASHVILLE STATE: TN ZIP: 37215 FORMER COMPANY: FORMER CONFORMED NAME: LIBERTE INVESTORS INC DATE OF NAME CHANGE: 19960701 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FORD GERALD J CENTRAL INDEX KEY: 0001021572 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12117 FILM NUMBER: 04828155 BUSINESS ADDRESS: STREET 1: 350 S GRAND AVENUE STREET 2: 52ND FLOOR CITY: LOS ANGELES STATE: CA ZIP: 90071 BUSINESS PHONE: 2132104931 MAIL ADDRESS: STREET 1: 350 S GRAND AVENUE STREET 2: 52ND FLOOR CITY: LOS ANGELES STATE: CA ZIP: 90071 4 1 bod15720_bod1gjf.xml MAIN DOCUMENT DESCRIPTION X0202 4 2004-05-21 0001017907 FIRST ACCEPTANCE CORP /DE/ FAC 0001021572 FORD GERALD J 200 CRESCENT COURT SUITE 1350 DALLAS TX 75201 1 1 1 0 Chairman Common Stock 2004-05-21 4 X 0 35482 4.00 A 14712854 I See Footnote. Subscription Rights (right to buy) 4.00 2004-05-21 4 J 0 35482 A 2004-05-21 2004-05-21 Common Stock 35482 35482 I See Footnote. Subscription Rights (right to buy) 4.00 2004-05-21 4 X 0 35482 D 2004-05-21 2004-05-21 Common Stock 35482 0 I See Footnote. Mr. Ford is a general partner of Hunter's Glen/Ford, Ltd., a Texas limited partnership ("HG/F"). Mr. Ford is also the settlor of Turtle Creek Revocable Trust ("TCRT"). On April 1, 2004, Liberte Investors Inc. ("Liberte") commenced a rights offering (the "Rights Offering") pursuant to which Liberte distributed pro rata to its stockholders subscription rights ("Rights") to purchase shares of common stock of Liberte at a purchase price of $4.00 per share. On December 15, 2003, HG/F entered into a certain Backstop Agreement (the "Backstop Agreement") with Liberte, pursuant to which HG/F agreed to purchase all Rights that were not exercised by stockholders of Liberte upon expiration of the Rights Offering. As of May 21, 2004, completed and executed certificates representing 35,482 Rights (the "Backstop Rights") were not properly delivered to the subscription agent for the Rights Offering in accordance with the Notice of Guaranteed Delivery procedures for the Rights Offering. On May 21, 2004, pursuant to its obligations under the Backstop Agreement, HG/F acquired the Backstop Rights and exercised the Backstop Rights to acquire 35,482 shares of common stock at a purchase price of $4.00 per share. Includes (i) 563,728 shares held by Mr. Ford, (ii) 12,919,408 shares held by HG/F and (iii) 1,229,718 shares held by TCRT. Not applicable. Mr. Ford expressly disclaims beneficial ownership of the securities reported herein, except to the extent of his pecuniary interest therein. /s/ Gerald J. Ford 2004-05-24 -----END PRIVACY-ENHANCED MESSAGE-----