0001140361-21-007038.txt : 20210302 0001140361-21-007038.hdr.sgml : 20210302 20210302203816 ACCESSION NUMBER: 0001140361-21-007038 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210226 FILED AS OF DATE: 20210302 DATE AS OF CHANGE: 20210302 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Boxer Gene CENTRAL INDEX KEY: 0001758152 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38731 FILM NUMBER: 21706673 MAIL ADDRESS: STREET 1: 14 WESLEY STREET CITY: HAMILTON STATE: D0 ZIP: HM11 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Sirius International Insurance Group, Ltd. CENTRAL INDEX KEY: 0001744894 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 980529995 STATE OF INCORPORATION: D0 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 14 WESLEY STREET, 5TH FLOOR CITY: HAMILTON STATE: D0 ZIP: HM11 BUSINESS PHONE: 1-441-278-3140 MAIL ADDRESS: STREET 1: 14 WESLEY STREET, 5TH FLOOR CITY: HAMILTON STATE: D0 ZIP: HM11 4 1 form4.xml FORM 4 X0306 4 2021-02-26 true 0001744894 Sirius International Insurance Group, Ltd. SG 0001758152 Boxer Gene 14 WESLEY STREET HAMILTON D0 HM11 BERMUDA true EVP, CSO & Group Gen. Counsel Common Shares 2021-02-26 4 D 0 8049 D 97646 D Common Shares 2021-02-26 4 D 0 97646 D 0 D Represents shares of common stock of the issuer ("Sirius Shares") disposed of in connection with the merger of the issuer with Third Point Reinsurance Ltd. ("TPRE") (the "Merger"), which closed on February 26, 2021 (the "Effective Time"), and exchanged for a combination of common shares, par value $0.10 per share, of TPRE (the "TPRE Shares") and contingent value right ("CVR") consideration comprising (1) 0.743 of a TPRE Share and (2) one contractual CVR, which represents the right to receive a contingent cash payment, which, taken together with the fraction of the TPRE Share received, guarantee that on the second anniversary of the Effective Time, the electing shareholder will have received equity and cash equal to at least $13.73 per Sirius Share. Represents restricted stock units ("RSUs") scheduled to vest in full on the third anniversary of grant date (or on February 27, 2022). These RSUs were disposed of in connection with the Merger and exchanged for 126,685 RSUs of TPRE common shares that immediately vested following the closing of the Merger and will be settled, net of shares withheld for taxes, for cash at the public trading price on the day of the cash-out. /s/ Gene Boxer 2021-03-02