SEC Form 3 · accession 0000904454-18-000169

SAFETY INSURANCE GROUP INC · SAFT

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Table I — non-derivative securities

Table II — derivative securities

Explanation of responses

• F1This Form 3 is being jointly filed by SRB Corporation, a Massachusetts corporation ("SRB"), The Plymouth Rock Company Incorporated, a Massachusetts corporation ("PRC"), and Palisades Safety and Insurance Association, a New Jersey reciprocal insurance exchange ("PSIA"), and each shall be deemed a Reporting Person. SRB is a direct, wholly-owned subsidiwy of PRC and acts as investment manager to each of PRC and PSIA, and, in such capacity, may be deemed to have voting and dispositive power over the shares of Common Stock reported on this Form 3. SRB disclaims beneficial ownership of the shares of Common Stock reported on this Form 3, and this report shall not be deemed an admission that SRB is a beneficial owner of such shares for purposes of Section 16 or for any other purpose. The Reporting Persons are making this single joint filing because they may be deemed a "group" within the meaning of Section 13(d)(3) of the Securities Act of 1934, as amended.
• F2PRC holds 539,296 of the shares of Common Stock reported on this Form 3. PRC includes the accounts of the following entities: Plymouth Rock Security Corporation, a Massachusetts security corporation ("PRSC"); Plymouth Rock Assurance Corporation, a Massachusetts corporation ("PRAC"); Pilgrim Insurance Company, a Massachusetts corporation; ("PIC"); Mt. Washington Assurance Corporation, a New Hampshire corporation; Bunker Hill Insurance Company, a Massachusetts corporation ("BHIC"); Bunker Hill Insurance Casualty Company, a Massachusetts corporation ("BHICC"); Bunker Hill Preferred Insurance Company, a Massachusetts corporation ("BHPREFIC"); Bunker Hill Property Insurance Company, a Massachusetts corporation ("BHPIC"); and Bunker Hill Security Insurance Company, a Massachusetts corporation ("BHSIC"). PRSC, PRAC, and BHIC are direct wholly-owned subsidiaries of PRC. PIC is a direct wholly-owned subsidiary of SRB.
• F3PSIA holds 997,937 of the shares of Common Stock reported on this Form 3. PSIA includes the accounts of High Point Safety and lnsurance Company, a New Jersey corporation ("HPSIC"); High Point Property and Casualty Insurance Company, a New Jersey corporation ("HPPCIC"); and High Point Preferred Insurance Company, a New Jersey corporation ("HPPIC"); Palisades Insurance Company, a New Jersey corporation ("PICNJ"); Twin Lights Insurance Company , a New Jersey corporation ("TLIC"); and Teachers Auto Insurance Company of New Jersey, a New Jersey corporation ("TAIC"). HPSIC, HPPIC, TLIC, and TAIC are direct wholly-owned subsidiaries of HPPCIC, which is a direct wholly-owned subsidiary of PSIA, as is PICNJ.

Remarks

Footnote #1 continued: This joint filing shall not, however, be deemed an affirmation that a group exists among the Reporting Persons for the purposes of the Securities Exchange Act of 1934 or for any other purpose and each Reporting Person expressly disclaims beneficial ownership of any securities beneficially owned by any other person. Footnote #2 continued: BHICC, BHPREFIC, BHPIC, and BHSIC are direct wholly-owned subsidiaries of BHIC. PRC disclaims beneficial ownership of the shares of Common Stock reported on this Form 3 except to the extent of its pecuniary interst therein, and this report shall not be deemed an admission that PRC is a beneficial owner of such shares for purposes of Section 16 or for any other purpose. Footnote #3 continued: PSIA disclaims beneficial ownership of the shares of Common Stock reported on this Form 3 except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that PSIA is a beneficial owner of such shares for purposes of Section 16 or for any other purposes.