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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 2270 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Warrants to Purchase Ordinary Shares | $ 7.5 | 12/31/2015 | Â | J | 36,915 | Â | Â (3) | 03/31/2019 | Ordinary Shares | (1) | 64,000 | See Footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Patel Paresh C/O OXBRIDGE RE HOLDINGS LIMITED 903 S. CHURCH ST., P.O. BOX 469 GRAND CAYMAN, E9 KY1-9006 |
 X |  |  |  |
/s/ Curt P. Creely, Attorney-in-Fact for Paresh Patel | 02/15/2016 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | On December 31, 2015, the reporting person bought out the other members of Dharma Partners, LLC, which is the 100% owner of Moksha Capital Partners Re (P) Ltd., which is the owner of 64,000 ordinary shares of the issuer and 64,000 warrants to purchase ordinary shares. As a result of the buyout, reporting person indirectly acquired beneficial ownership of all 64,000 ordinary shares and 64,000 warrants held by Moksha Capital Partners Re (P) Ltd., an increase of the 36,916 from the number of ordinary shares and warrants, respectively, previously reported as being held by the reporting person prior to the buyout. |
(2) | Shares are held by Moksha Capital Partners Re (P) Ltd., which is 100% owned by Dharma Partners, LLC. Reporting person is 100% owner of Dharma Partners, LLC. |
(3) | Immediately exercisable. |