-----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, QI4v35xkTBI7iI6EFGcxJ0GeB/zMy9IMGSokjTxtisJirZPr2y1pqC8qb3qKpwTe U8zmX3+Darv+v7oS5mETXg== 0001140361-10-051085.txt : 20101222 0001140361-10-051085.hdr.sgml : 20101222 20101222182539 ACCESSION NUMBER: 0001140361-10-051085 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20101222 FILED AS OF DATE: 20101222 DATE AS OF CHANGE: 20101222 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Vrban Michael CENTRAL INDEX KEY: 0001507310 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35009 FILM NUMBER: 101270016 MAIL ADDRESS: STREET 1: C/O FORTEGRA FINANCIAL CORPORATION STREET 2: 100 WEST BAY STREET CITY: JACKSONVILLE STATE: FL ZIP: 32202 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Fortegra Financial Corp CENTRAL INDEX KEY: 0001495925 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 581461399 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 WEST BAY STREET CITY: JACKSONVILLE STATE: FL ZIP: 32202 BUSINESS PHONE: 800-888-2738 MAIL ADDRESS: STREET 1: 100 WEST BAY STREET CITY: JACKSONVILLE STATE: FL ZIP: 32202 4 1 doc1.xml FORM 4 X0303 4 2010-12-22 0 0001495925 Fortegra Financial Corp FRF 0001507310 Vrban Michael C/O FORTEGRA FINANCIAL CORPORATION 100 WEST BAY STREET JACKSONVILLE FL 32202 0 1 0 0 EVP, CAO & Treas Common Stock, par value $0.01 per share 2010-12-22 4 C 0 15496 A 15496 D Common Stock, par value $0.01 per share 2625 I By wife Class A Common Stock, par value $0.01 per share 2010-12-22 4 C 0 2951 D Common Stock 15496 0 D The Class A Common Stock converted into Common Stock of Fortegra Financial Corporation on a 1 for 5.25 basis immediately prior to the consummation of the initial public offering and had no expiration date. /s/ John G. Short, Attorney-in-Fact 2010-12-22 -----END PRIVACY-ENHANCED MESSAGE-----