SEC Form 4 · accession 0001209191-15-085218
Fidelity & Guaranty Life · FGL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Rosanne Boehm
Officer — SVP, Human Resources
Period of report
Dec 12, 2015
Accepted (ET)
Dec 15, 2015 · 2:06 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001585064
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF2 | Dec 12, 2015 | F | 676 | $25.78 | D | 7,237 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Restricted Stock UnitF3 | — | holding | — | — | — | — | — | Common Stock | — | 567 | D |
| Stock Option (right to buy)F4 | $24.87 | holding | — | — | — | — | Dec 1, 2021 | Common Stock | 2,940 | 2,940 | D |
| Stock Option (right to buy)F5 | $38.14 | holding | — | — | — | — | Nov 2, 2018 | Common Stock | — | 2,040 | D |
| Stock Option (right to buy)F6 | $49.45 | holding | — | — | — | — | Dec 31, 2019 | Common Stock | — | 3,857 | D |
| Stock Option (right to buy)F7 | $17.00 | holding | — | — | — | — | Dec 12, 2020 | Common Stock | 4,545 | 4,545 | D |
Explanation of responses
- F1Represents the withholding by the Issuer of restricted stock to satisfy the reporting person's tax withholding obligations upon the vesting of restricted stock, which has been approved pursuant to the requirements of Rule 16b-3.
- F2Includes restricted stock.
- F3Each restricted stock unit is the economic equivalent of one share of Class B Common Stock of Fidelity & Guaranty Life Holdings, Inc., a wholly-owned subsidiary of the Issuer (the "F&G Subsidiary"). Each restricted stock unit will be settled upon vesting in cash in an amount equal to the fair market value of one share of Class B Common Stock of the F&G Subsidiary. It is expected that the fair market value of a share of Class B Common Stock of the F&G Subsidiary will be derived from the value of the Common Stock of the Issuer. The remaining restricted stock units will vest on December 31, 2015.
- F4The option vests in three equal annual installments on December 1, 2015, 2016 and 2017, subject to continued employment through such date.
- F5The option entitles the reporting person to receive, upon exercise, a cash payment equal to the excess of the fair market value of a share of Class A Common Stock of F&G Subsidiary, over the exercise price of the option. It is expected that the fair market value of a share of Class A Common Stock of the F&G Subsidiary will be derived from the value of the Common Stock of the Issuer. The option became exercisable as to 1,013 shares on November 2, 2012, 1,014 shares on November 2, 2013, and 1,013 shares on November 2, 2014.
- F6The option entitles the reporting person to receive, upon exercise, a cash payment equal to the excess of the fair market value of a share of Class B Common Stock of F&G Subsidiary, over the exercise price of the option. It is expected that the fair market value of a share of Class B Common Stock of the F&G Subsidiary will be derived from the value of the Common Stock of the Issuer. The option became exercisable as to 1,286 shares on December 31, 2013, 1,285 shares on December 31, 2014, and will become exercisable as to 1,286 shares on December 31, 2015.
- F7The option vests in three equal annual installments on December 12, 2014, 2015 and 2016, subject to continued employment through such date.