-----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, IQ6YpOeu07YKG7rGYrma40d1jEBQF+NiVvEq2a82xoLnBAH51Ft7WsEKsZzDLD4T GbPEKRP53mfy+9XOh3XoDw== 0001209191-10-061160.txt : 20101216 0001209191-10-061160.hdr.sgml : 20101216 20101216185007 ACCESSION NUMBER: 0001209191-10-061160 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20101216 FILED AS OF DATE: 20101216 DATE AS OF CHANGE: 20101216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Carroll John R CENTRAL INDEX KEY: 0001316158 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35009 FILM NUMBER: 101258017 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 3 1 c09766_3x1.xml MAIN DOCUMENT DESCRIPTION X0203 3 2010-12-16 0 0001495925 Fortegra Financial Corp FRF 0001316158 Carroll John R C/O SUMMIT PARTNERS, L.P. 222 BERKELEY STREET, 18TH FLOOR BOSTON MA 02116 1 0 0 0 Class A Common Stock, par value $0.01 per share Common Stock 13987447 I See remarks. The Class A Common Stock will convert 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 has no expiration date. Shares are held as follows: 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 entities mentioned in Footnote 2 collectively are referred to as the "Summit Entities." Summit Partners, L.P. is (i) 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., (ii) the managing member of Summit Partners SD III, LLC, which is the general partner of Summit Partners SD III, L.P., which is the general partner of Summit Subordinated Debt Fund III-A, L.P. and Subordinated Debt Fund III-B, L.P. and (iii) 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. 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 shares. Mr. Carroll is a member of the general partner of Summit Partners, L.P. Mr. Carroll disclaims beneficial ownership of the shares listed in Footnote 2, and this report shall not be deemed an admission that Mr. Carroll is the beneficial owner of such shares for the purpose of Section 16 or for any other purpose, except, in each case, to the extent of Mr. Carroll's pecuniary interest therein. Exhibit List: Exhibit 24 - Power of Attorney /s/ Robin Devereux, Power of Attorney for John Carroll 2010-12-16 EX-24 2 c09766_24.htm POWER OF ATTORNEY POWER OF ATTORNEY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that each person whose signature appears below hereby constitutes and appoints Robin W. Devereux his or her true and lawful attorney-in-fact and agent, with full power of substitution and resubstitution, for him or her and in his or her name, place and stead, in any and all capacities (until revoked in writing) to sign any and all instruments, certificates and documents required to be executed on behalf of himself or herself individually or on behalf of each of any affiliate of Summit Partners, L.P. that is not a portfolio company, including without limitation those entities listed on the attached Exhibit A, on matters relating to:
  (a)  
Sections 13 and 16 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), Rule 144 promulgated under the Securities Act of 1933, as amended (the “33 Act”) and any and all regulations promulgated thereunder, including filings with the Securities and Exchange Commission pursuant thereto;
 
  (b)  
any written ballot or proxy with respect to any investment securities owned beneficially or of record by any such entities;
 
  (c)  
such filings required pursuant to the Internal Revenue Code of 1986, as amended, and any related regulations, pertaining to such entities
 
  (d)  
economic exhibits relating to such entities; and
 
  (e)  
the PATRIOT Act.
and to file the same, with all exhibits thereto, and any other documents in connection therewith, with, as applicable, (i) the Securities and Exchange Commission, and with any other entity when and if such is mandated by the Exchange Act or by the By-laws of the National Association of Securities Dealers, and/or (ii) the Internal Revenue Service, granting unto said attorney-in-fact and agent full power and authority to do and perform each and every act and thing requisite and necessary fully to all intents and purposes as he or she might or could do in person thereby ratifying and confirming all that said attorney-in-fact and agent, or his or her substitute or substitutes, may lawfully do or cause to be done by virtue hereof. Said attorney-in-fact is entitled to amend Exhibit A from time to time to reflect additional affiliates of Summit Partners, L.P. that are not portfolio companies.
The undersigned hereby acknowledges that this Power of Attorney supercedes, revokes and terminates any power of attorney executed by the undersigned prior to the date hereof for the purposes listed above.
[Exhibit A and Signature Pages Follow]

 

 

 

Power of Attorney
Exhibit A
     
HKL I Partners
  Summit Accelerator Management, LLC
HKL I, LLC
  Summit Accelerator Management, L.P.
SD II Bennington Blocker Corp.
  Summit Accelerator Partners, LLC
SD II Eyeglass Blocker Corp.
  Summit Accelerator Partners, L.P.
SD II Eyeglass Holdings, L.P.
  Summit Founders’ Fund II, L.P.
SD III-B Nomacorc Blocker Corp.
  Summit Founders’ Fund, L.P.
SD III-B Nomacorc Holdings, L.P.
  Summit GmbH & Co. Beteiligungs KG
SD III-B Tippmann Blocker Corp.
  Summit Incentive Plan II, L.P.
SD III-B Tippmann Holdings, L.P.
  Summit Incentive Plan, L.P.
SD III-B Tivoli Blocker Corp.
  Summit Investment Holdings Trust
SD III-B Tivoli Holdings, L.P.
  Summit Investment Holdings Trust II
SD III-B TUI Blocker Corp.
  Summit Investors (SAF) IV, L.P.
SD III-B TUI Holdings, L.P.
  Summit Investors Holdings Trust
SDIII-B Focus Blocker Corp.
  Summit Investors I (UK), L.P.
SDIII-B Focus Holdings, L.P.
  Summit Investors I, LLC
Shearson Summit Partners Management, L.P.
  Summit Investors II, L.P.
SP (1984), L.P.
  Summit Investors III, L.P.
SP PE VII-B Announce Blocker Corp.
  Summit Investors Management, LLC
SP PE VII-B Announce Holdings, L.P.
  Summit Investors VI, L.P.
SP PE VII-B Nomacorc Holdings, L.P.
  Summit Investors, L.P.
SP VC II-B TMFS Blocker Corp.
  Summit LogistiCare LLC
SP VC II-B TMFS Holdings, L.P.
  Summit Master Company, LLC
Sparta Holding Corporation
  Summit Parners III S.a.r.l.
SPPE VII-B Aurora Blocker Corp.
  Summit Partner PE VII, LLC
SPPE VII-B Aurora Holdings, L.P.
  Summit Partner PE VII, L.P.
SPPE VII-B CD Blocker Corp.
  Summit Partners Blocker, Inc.
SPPE VII-B Champion Blocker Corp.
  Summit Partners Europe Private Equity Fund, L.P.
SPPE VII-B Nomacorc Blocker Corp.
  Summit Partners Europe, L.P.
SPPE VII-B SUN Blocker Corp.
  Summit Partners Europe, LTD.
SPPE VII-B SUN Holdings, L.P.
  Summit Partners F.F. Corp.
SPPE VII-B TUI Blocker Corp.
  Summit Partners Holdings, L.P.
SPPE VII-B TUI Holdings, L.P.
  Summit Partners II S.a.r.l.
SPVCII-B Anesthetix Blocker Corp.
  Summit Partners II, L.P.
SPVCII-B LiveOffice Blocker Corp.
  Summit Partners III, L.P.
Stamps, Woodsum & Co.
  Summit Partners IV, L.P.
Stamps, Woodsum & Co. II
  Summit Partners, LLC
Stamps, Woodsum & Co. III
  Summit Partners Private Equity Fund VII-A, L.P.
Stamps, Woodsum &Co. IV
  Summit Partners Private Equity Fund VII-B, L.P.
Summit Accelerator Founders’ Fund, L.P.
  Summit Partners S.a.r.l.
Summit Accelerator Fund, L.P.
  Summit Partners SD II, LLC

 

 

 

Power of Attorney

Exhibit A
     
Summit Partners SD III, L.P.
  Summit Ventures V, L.P.
Summit Partners SD III, LLC
  Summit Ventures VI-A, L.P.
Summit Partners SD IV, LLC
  Summit Ventures VI-B HCP Blocker Corp.
Summit Partners SD IV, LP
  Summit Ventures VI-B HCP, L.P.
Summit Partners SD IV-A, LP
  Summit Ventures VI-B, L.P.
Summit Partners SD IV-B, LP
  Summit Ventures, L.P.
Summit Partners SD, L.P.
  Summit Verwaltings GmbH
Summit Partners V S.a.r.l.
  Summit VI Advisors Fund, L.P.
Summit Partners V, L.P.
  Summit VI Entrepreneurs Fund L.P.
Summit Partners VC II LLC
  Summit/CAM Holdings, LLC
Summit Partners VC II LP
  Summit/Meditech LLC
Summit Partners Venture Capital Fund II-A, L.P.
  Summit/Sun Holdings, LLC
Summit Partners Venture Capital Fund II-B, L.P.
  SV Eurofund, C.V.
Summit Partners VI (GP), L.P.
  SV International, L.P.
Summit Partners VI (GP), LLC
  SV VI -B Eyeglass Common Blocker Corp.
Summit Partners VI-A France
  SV VI -B Eyeglass Preferred Blocker Corp.
Summit Partners VI-A S.a.r.l.
  SV VI B Tippmann Common Blocker Corp.
Summit Partners VI-B France
  SV VI B Tippmann Preferred Blocker Corp.
Summit Partners VI-B S.a.r.l.
  SV VI Tippmann Holdings. L.P.
Summit Partners VII-A S.a.r.l.
  SV VI-B Aurora Blocker Corp.
Summit Partners VII-B S.a.r.l.
  SV VI-B Aurora Holdings, L.P.
Summit Partners VIII S.a.r.l.
  SV VI-B Bennington Blocker Corp.
Summit Partners, L.P.
  SV VI-B Bennington Holdings, L.P.
Summit Partners, LP Profit Sharing Plan and Trust
  SV VI-B CAM Blocker Corp.
Summit Partners, LP Savings and Investment Plan
  SV VI-B CAM Holdings, L.P.
Summit Partners, Ltd.
  SV VI-B CD Blocker Corp.
Summit Retained Earnings, L.P.
  SV VI-B CD Holdings, L.P.
Summit Subordinated Debt Fund II, L.P.
  SV VI-B Commnet Common Blocker Corp.
Summit Subordinated Debt Fund III-A, L.P.
  SV VI-B Commnet Holdings, L.P.
Summit Subordinated Debt Fund III-B, L.P.
  SV VI-B Commnet Preferred Blocker Corp.
Summit Subordinated Debt Fund, L.P.
  SV VI-B Eyeglass Holdings, L.P.
Summit TRI, L.P.
  SV VI-B Focus Blocker Corp.
Summit UK Advisory LLC
  SV VI-B Focus Holdings, L.P
Summit V Advisors Fund QP, L.P.
  SV VI-B LiteCure Blocker Corp.
Summit V Advisors Fund, L.P.
  SV VI-B LiteCure, L.P.
Summit V Companion Fund, L.P.
  SV VI-B Tippmann Holdings. L.P.
Summit Ventures II, L.P.
  SV VI-B Tivoli Blocker Corp.
Summit Ventures III, L.P.
  SV VI-B Tivoli Holdings, LP
Summit Ventures IV, L.P.
  SWC Holdings CO.

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 27 day of August, 2008.
         
     
/s/ Gregory M. Avis      
Gregory M. Avis     
     
 
             
State of California
    )      
          )
  ss:      
County of San Mateo
    )      
On this 27 day of August, 2008, before me personally came Gregory M. Avis, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Lisa Franco      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ John R. Carroll      
John R. Carroll     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:      
County of Suffolk
    )      
On this 15 day of September, 2008, before me personally came John R. Carroll, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 18 day of August, 2008.
         
     
/s/ Peter Y. Chung      
Peter Y. Chung     
     
 
             
State of California
    )      
          )
  ss:      
County of San Mateo
    )      
On this 18 day of August, 2008, before me personally came Peter Y. Chung, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Elisa Leonhardt      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 5 day of Sept., 2008.
         
     
/s/ Scott C. Collins      
Scott C. Collins     
     
 
             
Kingdom of England
    )      
          )
  ss:      
City of London
    )      
On this 5th day of September, 2008, before me personally came Scott C. Collins, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Edward Gardiner      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ Christopher J. Dean      
Christopher J. Dean     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:      
County of Suffolk
    )      
On this 15 day of September, 2008, before me personally came Christopher J. Dean, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ Bruce R. Evans      
Bruce R. Evans     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:        
County of Suffolk
    )      
On this 15 day of September, 2008, before me personally came Bruce R. Evans, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 18 day of August, 2008.
         
     
/s/ Charles J. Fitzgerald      
Charles J. Fitzgerald     
     
 
             
State of California
    )      
          )
  ss:      
County of San Mateo
    )      
On this 18 day of August, 2008, before me personally came Charles J. Fitzgerald, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Elisa Leonhardt      
Notary Public     
     
 

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 21 day of August, 2008.
         
     
/s/ Craig D. Frances      
Craig D. Frances     
     
 
             
State of California
    )      
          )
  ss:      
County of San Mateo
    )      
On this 21 day of August, 2008, before me personally came Craig D. Frances, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Elisa Leonhardt      
Notary Public     
     

 

 

 

         
IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ Thomas H. Jennings      
Thomas H. Jennings     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:      
County of Suffolk
    )      
On this 15 day of September, 2008, before me personally came Thomas H. Jennings, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 18 day of August, 2008.
         
     
/s/ Walter G. Kortschak      
Walter G. Kortschak     
     
 
             
State of California
    )      
          )
  ss:      
County of San Mateo
    )      
On this 18 day of August, 2008, before me personally came Walter G. Kortschak, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Elisa Leonhardt      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 5th day of September, 2008.
         
     
/s/ Sotiris T. Lyritzis      
Sotiris T. Lyritzis     
     
 
             
Kingdom of England
    )      
          )
  ss:      
City of London
    )      
On this 5th day of September, 2008, before me personally came Sotiris T. Lyritzis, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Edward Gardiner      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ Martin J. Mannion      
Martin J. Mannion     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:      
County of Suffolk
    )      
On this 15 day of September, 2008, before me personally came Martin J. Mannion, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 12 day of August, 2008.
         
     
/s/ Harrison B. Miller      
Harrison B. Miller     
     
 
             
State of California
    )      
          )
  ss:      
County of San Mateo
    )      
On this 12 day of August, 2008, before me personally came Harrison B. Miller, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Lisa Franco      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ Kevin P. Mohan      
Kevin P. Mohan     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:      
County of Suffolk
    )      
On this 15 day of September, 2008, before me personally came Kevin P. Mohan, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     
 

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ Thomas S. Roberts      
Thomas S. Roberts     
     
 
                 
Commonwealth of Massachusetts
     )          
          )
  ss:          
County of Suffolk
     )          
On this 15 day of September, 2008, before me personally came Thomas S. Roberts, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 10 day of September, 2008.
         
     
/s/ E. Roe Stamps      
E. Roe Stamps     
     
 
             
State of Florida
    )      
          )
  ss:      
County of Monroe
    )      
On this 10 day of September, 2008, before me personally came E. Roe Stamps, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Joanne Muniz      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ Joseph F. Trustey      
Joseph F. Trustey     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:      
County of Suffolk
    )      
On this 15 day of September, 2008, before me personally came Joseph F. Trustey, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 15 day of September, 2008.
         
     
/s/ Stephen G. Woodsum      
Stephen G. Woodsum     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:      
Country of Suffolk
    )      
On this 15 day of September, 2008, before me personally came Stephen G. Woodsum, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Peter Danbridge      
Notary Public     
     

 

 

 

IN WITNESS WHEREOF, this Power of Attorney has been signed as of the 9th day of December, 2010.
         
     
/s/ Joseph J. Kardwell      
Joseph J. Kardwell     
     
 
             
Commonwealth of Massachusetts
    )      
          )
  ss:        
Country of Suffolk
    )      
On this 9 day of December, 2010, before me personally came Joseph J. Kardwell, known to me to be the person described and who executed the foregoing instrument that he acknowledged and executed the same.
[Notary Seal]
         
     
/s/ Ma Laarni Canoy      
Notary Public     
     
 

 

 

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