0000899243-20-030104.txt : 20201102 0000899243-20-030104.hdr.sgml : 20201102 20201102171250 ACCESSION NUMBER: 0000899243-20-030104 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201030 FILED AS OF DATE: 20201102 DATE AS OF CHANGE: 20201102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INSIGNIA CAPITAL PARTNERS GP, L.L.C. CENTRAL INDEX KEY: 0001829474 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39671 FILM NUMBER: 201281248 BUSINESS ADDRESS: STREET 1: 1333 NORTH CALIFORNIA BOULEVARD STREET 2: SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 BUSINESS PHONE: (925) 399-8900 MAIL ADDRESS: STREET 1: 1333 NORTH CALIFORNIA BOULEVARD STREET 2: SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Insignia Capital Partners, L.P. CENTRAL INDEX KEY: 0001586847 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39671 FILM NUMBER: 201281249 BUSINESS ADDRESS: STREET 1: 1333 N. CALIFORNIA BLVD, SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 BUSINESS PHONE: (925) 399-8900 MAIL ADDRESS: STREET 1: 1333 N. CALIFORNIA BLVD, SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INSIGNIA CAPITAL PARTNERS (AIV), L.P. CENTRAL INDEX KEY: 0001829472 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39671 FILM NUMBER: 201281250 BUSINESS ADDRESS: STREET 1: 1333 NORTH CALIFORNIA BOULEVARD STREET 2: SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 BUSINESS PHONE: (925) 399-8900 MAIL ADDRESS: STREET 1: 1333 NORTH CALIFORNIA BOULEVARD STREET 2: SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Insignia Capital Partners (Parallel A), L.P. CENTRAL INDEX KEY: 0001586845 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39671 FILM NUMBER: 201281251 BUSINESS ADDRESS: STREET 1: TWO WALNUT CREEK CENTER STREET 2: 200 PRINGLE AVENUE, SUITE 400 CITY: WALNUT CREEK STATE: CA ZIP: 94596 BUSINESS PHONE: (925)399-8900 MAIL ADDRESS: STREET 1: TWO WALNUT CREEK CENTER STREET 2: 200 PRINGLE AVENUE, SUITE 400 CITY: WALNUT CREEK STATE: CA ZIP: 94596 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INSIGNIA QL HOLDINGS, LLC CENTRAL INDEX KEY: 0001829475 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39671 FILM NUMBER: 201281252 BUSINESS ADDRESS: STREET 1: 1333 NORTH CALIFORNIA BOULEVARD STREET 2: SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 BUSINESS PHONE: (925) 399-8900 MAIL ADDRESS: STREET 1: 1333 NORTH CALIFORNIA BOULEVARD STREET 2: SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INSIGNIA A QL HOLDINGS, LLC CENTRAL INDEX KEY: 0001829476 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39671 FILM NUMBER: 201281253 BUSINESS ADDRESS: STREET 1: 1333 NORTH CALIFORNIA BOULEVARD STREET 2: SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 BUSINESS PHONE: (925) 399-8900 MAIL ADDRESS: STREET 1: 1333 NORTH CALIFORNIA BOULEVARD STREET 2: SUITE 520 CITY: WALNUT CREEK STATE: CA ZIP: 94596 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MediaAlpha, Inc. CENTRAL INDEX KEY: 0001818383 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE CARRIERS, NEC [6399] IRS NUMBER: 851854133 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 700 SOUTH FLOWER STREET STREET 2: SUITE 640 CITY: LOS ANGELES STATE: CA ZIP: 90017 BUSINESS PHONE: 619-393-9368 MAIL ADDRESS: STREET 1: 700 SOUTH FLOWER STREET STREET 2: SUITE 640 CITY: LOS ANGELES STATE: CA ZIP: 90017 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2020-10-30 0 0001818383 MediaAlpha, Inc. MAX 0001829474 INSIGNIA CAPITAL PARTNERS GP, L.L.C. 1333 NORTH CALIFORNIA BOULEVARD, STE 520 WALNUT CREEK CA 94596 0 0 1 0 0001586847 Insignia Capital Partners, L.P. 1333 NORTH CALIFORNIA BOULEVARD, STE 520 WALNUT CREEK CA 94596 0 0 1 0 0001829472 INSIGNIA CAPITAL PARTNERS (AIV), L.P. 1333 NORTH CALIFORNIA BOULEVARD, STE 520 WALNUT CREEK CA 94596 0 0 1 0 0001586845 Insignia Capital Partners (Parallel A), L.P. 1333 NORTH CALIFORNIA BOULEVARD, STE 520 WALNUT CREEK CA 94596 0 0 1 0 0001829475 INSIGNIA QL HOLDINGS, LLC 1333 NORTH CALIFORNIA BOULEVARD, STE 520 WALNUT CREEK CA 94596 0 0 1 0 0001829476 INSIGNIA A QL HOLDINGS, LLC 1333 NORTH CALIFORNIA BOULEVARD, STE 520 WALNUT CREEK CA 94596 0 0 1 0 Class B Common Stock 2020-10-30 4 J 0 1869877 D 10635407 I See Footnote Class B-1 Units 0.00 2020-10-30 4 S 0 1869877 17.67 D Class A Common Stock 1869877 10635407 I See Footnote On October 30, 2020, the Issuer used a portion of the net proceeds from the closing of its initial public offering ("IPO") of Class A Common Stock to purchase Class B-1 Units of QL Holdings, LLC (the "LLC") from certain of the Issuer's pre-IPO equityholders, including the Reporting Persons (the "Synthetic Secondary"), at a price of $17.67 per unit. To the extent Class B-1 Unit holders own shares of the Issuer's Class B Common Stock (the "Class B Shares"), one share of Class B Common Stock for every Class B-1 Unit sold in the Synthetic Secondary was forfeited and cancelled for no consideration. Includes 824,871 Class B Shares forfeited and cancelled for no consideration by Insignia A QL Holdings, LLC ("Insignia A") and 1,045,006 Class B Shares forfeited and cancelled for no consideration by Insignia QL Holdings, LLC ("Insignia QL") in connection with the Synthetic Secondary. Includes 4,691,665 Class B Shares held directly by Insignia A and 5,943,742 Class B Shares held directly by Insignia QL. Insignia Capital Partners (Parallel A), L.P. ("Parallel A") and Insignia Capital Partners (AIV), L.P. ("Insignia AIV") are members of Insignia A having the power to appoint the majority of the board of managers of Insignia A. Insignia Capital Partners, L.P. ("Insignia Capital" and together with Parallel A and Insignia AIV, the "Insignia Fund") is the managing member of Insignia QL. Insignia Capital Partners GP, LLC ("Insignia GP") is the general partner of the Insignia Fund. The three member Investment Committee of Insignia GP comprised of David Lowe, Anthony Broglio and Melvyn Deane exercises voting and investment control over the securities held directly by Insignia A and Insignia QL, which acts by a majority vote of its members. (Continued from footnote 3) Consequently, the Insignia Fund and Insignia GP may be deemed to beneficially own the securities held directly by Insignia A and Insignia QL. Messrs. Lowe, Broglio and Deane disclaim beneficial ownership of the securities held directly by Insignia A and Insignia QL. Includes 824,871 Class B-1 Units sold by Insignia A and 1,045,006 Class B-1 Units sold by Insignia QL in the Synthetic Secondary. Pursuant to the Exchange Agreeement, dated October 27, 2020, by and among the Issuer, the LLC and the members of the LLC (the "Exchange Agreement"), the Class B-1 Units of the LLC (together with one Class B Share of the Issuer for every Class B-1 Unit) are exchangeable at any time for one shares of the Issuer's Class A Common Stock. Class B-1 Units of the LLC do not expire. Includes 4,691,665 Class B-1 Units of the LLC held directly by Insignia A and 5,943,742 Class B-1 Units of the LLC held directly by Insignia QL. /s/ Tony Broglio, as Managing Member of Insignia Capital Partners GP, LLC 2020-11-02 /s/ Tony Broglio, as Managing Member of Insignia Capital Partners LP 2020-11-02 /s/ Tony Broglio, as Managing Member of Insignia Capital Partner (AIV), LP 2020-11-02 /s/ Tony Broglio, as Managing Member of Insignia Capital Partner (Parralel A), LP 2020-11-02 /s/ Tony Broglio, as President and Secretary of Insignia QL Holdings, LLC 2020-11-02 /s/ Tony Broglio, as President and Secretary of Insignia A QL Holdings, LLC 2020-11-02