-----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, UW2iIRrhmlU0OYhTU4DChxY3gy5ne1TdcA/clibPty/5xkgbrocSu6/k0FIy+Fe6 DyTc+XR3/TKN4Ke1f2o6aQ== 0001005477-07-000591.txt : 20070130 0001005477-07-000591.hdr.sgml : 20070130 20070130214147 ACCESSION NUMBER: 0001005477-07-000591 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20070130 FILED AS OF DATE: 20070130 DATE AS OF CHANGE: 20070130 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Employers Holdings, Inc. CENTRAL INDEX KEY: 0001379041 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 043850065 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 9790 GATEWAY DRIVE CITY: RENO STATE: NV ZIP: 89521 BUSINESS PHONE: 775-327-2936 MAIL ADDRESS: STREET 1: 9790 GATEWAY DRIVE CITY: RENO STATE: NV ZIP: 89521 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kolesar Robert J CENTRAL INDEX KEY: 0001388051 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33245 FILM NUMBER: 07566161 BUSINESS ADDRESS: BUSINESS PHONE: 775-327-2764 MAIL ADDRESS: STREET 1: 9790 GATEWAY DRIVE STREET 2: SUITE 200 CITY: RENO STATE: NV ZIP: 89521 3 1 edgar123.xml FORM 3 X0202 3 2007-01-30 0 0001379041 Employers Holdings, Inc. EIG 0001388051 Kolesar Robert J 9790 GATEWAY DRIVE RENO NV 89521 1 0 0 0 No securities are beneficially owned 0 I See footnotes 1 and 2 As of the date of this Form 3, Mr. Kolesar has no direct or indirect beneficial interests in any securities of Employers Holdings, Inc. (the "Company"). Mr. Kolesar is the managing partner of Kolesar & Leatham, Chtd., a Las Vegas law firm, which holds a policy issued by Employers Insurance Company of Nevada, a wholly-owned subsidiary of the Company. The policy owned by Kolesar & Leatham, Chtd. entitles it to receive consideration consisting of an estimated 1,041 shares of common stock (assuming no exercise of the over-allotment option granted by the Company to the underwriters) as a result of the conversion of the Company from a Nevada mutual insurance company owned by its policyholders to a Nevada stock corporation. If the over-allotment option is exercised, Kolesar & Leatham, Chtd.'s, entitlement to consideration in the conversion will change. By virtue of his ownership interests in Kolesar & Leatham, Chtd., Mr. Kolesar may be deemed to beneficially own any shares listed as beneficially owned by Kolesar & Leatham, Chtd. Mr. Kolesear will disclaim beneficial ownership of such shares except to the extent of his pecuniary interests therein and the inclusion of the shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose. /s/ Lenard T. Ormsby, as attorney-in-fact for Robert J. Kolesar 2007-01-30 -----END PRIVACY-ENHANCED MESSAGE-----