SEC Form 4 · accession 0001017636-16-000003
Protective Insurance Corp · PTVCA / B
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Nathan Shapiro
Director · 10% Owner
Period of report
May 10, 2016
Accepted (ET)
May 11, 2016 · 4:31 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000009346
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class B Common StockF4 | May 10, 2016 | A | 1,607 | — | A | 108,744 | D | |
| Class A Common Stock | holding | — | — | — | 146,645 | D | ||
| Class A Common StockF1 | holding | — | — | — | 239,296 | I | Various | |
| Class A Common StockF3 | holding | — | — | — | 755,009 | I | Various | |
| Class B Common StockF1 | holding | — | — | — | 613,125 | I | Various | |
| Class B Common StockF3 | holding | — | — | — | 1,799,375 | I | Various |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Right to sell (put)F2 | — | holding | — | — | — | Dec 31, 1981 | — | Class B Common | 187,500 | 187,500 | D |
| Right to sell (put)F2 | — | holding | — | — | — | Dec 31, 1981 | — | Class A Common | 46,875 | 46,875 | D |
Explanation of responses
- F1Owned by (a) New Horizons, Inc., (42,750 shares of Class A and 32,000 shares of class B) of which the undersigned is controlling stockholder; (b) Illinois Diversified, (21,375 shares of Class A and 85,500 shares of Class B) a general partnership as to which beneficial ownership is held by the undersigned; and (c) NS Associates, Inc., (173,062 shares of Class A and 495,625 shares of Class B) of which the undersigned is the controlling shareholder.
- F2All puts are exercisable at any time at 90% of the Company's most recently published quarterly book value prior to the date of exercise. These rights have no expiration date.
- F3Owned by (a) Gelbart Fur Dressers (not Inc.), (178,500 shares of Class A and 714,000 shares of Class B) and Jay Ell Company (not Inc.), (41,250 shares of Class A and 165,000 shares of Class B) limited partnerships; (b) Diversified Enterprises (not Inc.), (178,125 shares of Class A and 559,500 shares of Class B) a general partnership; (c) Shapiro Family L.P. - Gift Share (353,250 shares of Class A and 360,875 shares of Class B); ) and (d) Emlin Cosmetics, Inc. (3,884 shares of Class A). Beneficial ownership is shared by the undersigned and other family members for all shares owned by these entities.
- F4Shares represent restricted stock granted in lieu of certain cash director's fees. Restrict stock vests and is distributable on May 10, 2017.