0001567619-21-007952.txt : 20210413 0001567619-21-007952.hdr.sgml : 20210413 20210413115052 ACCESSION NUMBER: 0001567619-21-007952 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210302 FILED AS OF DATE: 20210413 DATE AS OF CHANGE: 20210413 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CABILLOT RAYMOND E CENTRAL INDEX KEY: 0001361476 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36346 FILM NUMBER: 21822448 MAIL ADDRESS: STREET 1: 3033 EXCELSIOR BLVD. STREET 2: STE 560 CITY: MINNEAPOLIS STATE: MN ZIP: 55416 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: OXBRIDGE RE HOLDINGS Ltd CENTRAL INDEX KEY: 0001584831 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 981150254 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: STRATHVALE HOUSE, 2ND FLOOR, PO BOX 469 STREET 2: 90 NORTH CHURCH STREET CITY: GEORGETOWN STATE: E9 ZIP: KY1-9006 BUSINESS PHONE: 345-749-7570 MAIL ADDRESS: STREET 1: STRATHVALE HOUSE, 2ND FLOOR, PO BOX 469 STREET 2: 90 NORTH CHURCH STREET CITY: GEORGETOWN STATE: E9 ZIP: KY1-9006 4 1 doc1.xml FORM 4 X0306 4 2021-03-02 0 0001584831 OXBRIDGE RE HOLDINGS Ltd OXBR 0001361476 CABILLOT RAYMOND E C/O OXBRIDGE RE HOLDINGS LIMITED 103 S. CHURCH ST., P.O. BOX 469 GRAND CAYMAN E9 KY1-9006 CAYMAN ISLANDS 1 0 0 0 Ordinary Shares, Par Value $0.001 7225 I See footnote (1) Ordinary Shares, Par Value $0.001 47045 I See footnote (2) Ordinary Shares, Par Value $0.001 35000 D Share Options (right to buy) 6.00 2021-03-02 4 A 0 50000 0 A 2031-03-02 Ordinary Shares 50000 50000 D 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. 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. This option grant was previously reported on a Form 8-K filed by the issuer on March 8, 2021. 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. /s/ Raymond E. Cabillot 2021-04-12