-----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, CAL0MxGj9iYJgilQm2M9Op6O+VcyAeyanN28ynHxEFErzVDE7G082RvZvr4pa9e0 k/1H8f+oSfXjOAaU65mJOA== 0001179110-10-018029.txt : 20101222 0001179110-10-018029.hdr.sgml : 20101222 20101222132102 ACCESSION NUMBER: 0001179110-10-018029 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: Carroll John R CENTRAL INDEX KEY: 0001316158 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35009 FILM NUMBER: 101267959 MAIL ADDRESS: STREET 1: C/O SUMMIT PARTNERS STREET 2: 222 BERKELEY STREET, 18TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 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 edgar.xml FORM 4 - X0303 4 2010-12-22 0 0001495925 Fortegra Financial Corp FRF 0001316158 Carroll John R C/O SUMMIT PARTNERS 222 BERKELEY STREET, 18TH FLOOR BOSTON MA 02116 1 0 0 0 Common Stock 2010-12-22 4 C 0 13987447 A 13987447 I See remarks. Common Stock 2010-12-22 4 S 0 1548675 10.23 D 12438772 I See remarks. Class A Common Stock, par value $0.01 per share 2010-12-22 4 C 0 2664275 0 D Common Stock 13987447 0 I See remarks. Represents shares sold by the following Entities: 894,669 sold by Summit Partners Private Equity Fund VII-A, L.P., 537,352 sold by Summit Partners Private Equity Fund VII-B, L.P., 73,670 sold by Summit Subordinated Debt Fund III-A, L.P., 38,377 sold by Summit Subordinated Debt Fund III-B, L.P., 4,607 shares sold by Summit Investors VI, L.P. Represents shares held by the following Entities: 7,185,781 in the name of Summit Partners Private Equity Fund VII-A, L.P.; 4,315,949 in the name of Summit Partners Private Equity Fund VII-B, L.P.; 591,713 in the name of Summit Subordinated Debt Fund III-A, L.P.; 308,237 in the name of Summit Subordinated Debt Fund III-B, L.P.; 37,002 in the name of Summit Investors VI, L.P. Represents shares acquired by the Entities upon conversion of the Class A Common Stock: 8,080,540 in the name of Summit Partners Private Equity Fund VII-A, L.P., 4,853,301 in the name of Summit Partners Private Equity Fund VII-B, L.P., 665,383 in the name of Summit Subordinated Debt Fund III-A, L.P., 346,614 in the name of Summit Subordinated Debt Fund III-B, L.P., and 41,609 in the name of Summit Investors VI, L.P. The Class A Common Stock converted into Common Stock of Fortegra Financial Corporation on a 1 for 5.25 basis and had no expiration date. The entities mentioned in Footnotes 1 through 3 are collectively referred to as the "Summit Entities." Summit Partners, L.P. is (i) the managing member of Summit Partners VI (GP),LLC, which is the general partner of Summit Partners VI (GP), L.P., which is the general partner of Summit Investors VI, L.P.; (ii)the managing member of Summit Partners Subordinated Debt III, LLC, which is the general partner of Subordinated Debt III, L.P., which is the general partner of Summit Subordinated Debt III-A Fund, L.P. and Summit Subordinated Debt III-B Fund, L.P.; (iii)the managing member of Summit Partners PE VII, LLC, which is the general partner of Summit Partners PE VII, L.P., which is the general partner of Summit Partners Private Equity Fund VII-A, L.P. and Summit Partners Private Equity Fund VII-B, L.P. Summit Partners, L.P., through a two-person investment committee, has voting and dispositive authority over the shares held by the Summit Entities, and therefore may beneficially own such s hares. Mr. Carroll is a member of the general partner of Summit Partners, L.P. Mr. Carroll disclaims beneficial ownership of shares, and this report shall not be deemed an admission that Mr. Carroll is the beneficial owner of the shares for the purposes of Section 16 of for any other purpose, except, in each case, to the extent of Mr. Carroll's pecuniary interest therein. Robin W. Devereux, Power of Attorney for John R. Carroll 2010-12-22 -----END PRIVACY-ENHANCED MESSAGE-----