SEC Form 4 · accession 0001365555-18-000175
Amtrust Financial Services, Inc. · AFSI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Leah Karfunkel
Director · 10% Owner
Period of report
Nov 29, 2018
Accepted (ET)
Nov 30, 2018 · 4:07 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001365555
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Nov 29, 2018 | D | 2,114,774 | — | D | 0 | I | By Grantor Retained Annuity Trust |
| Common StockF2 | Nov 29, 2018 | D | 19,729,562 | — | D | 0 | I | By Family Trust |
| Common StockF1,F2 | Nov 29, 2018 | D | 256,689 | — | D | 0 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On October 24, 2018, the Leah Karfunkel 2016-AMT GRAT distributed 256,689 shares of Common Stock by its terms to Leah Karfunkel personally.
- F2Pursuant to the Rollover Agreement dated as of March 1, 2018, among the reporting person and Evergreen Parent, L.P. ("Parent"), the reporting person agreed to contribute these shares to Parent (the "Rollover") in exchange for common limited partnership interests in Parent, effective as of the effective time of the merger contemplated by the Agreement and Plan of Merger dated as of March 1, 2018 and as amended June 6, 2018, by and among AmTrust Financial Services, Inc., Parent and Evergreen Merger Sub, Inc. For purposes of the Rollover, the reporting person's shares were valued at $13.50 per share.