1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Warrants
|
06/11/2010 |
06/11/2020 |
Common Stock
|
660,000
(1)
|
$
1.03
|
I
|
Signature Group Holdings, LLC
|
Warrants
|
06/11/2011 |
06/11/2020 |
Common Stock
|
660,000
(1)
|
$
1.03
|
I
|
Signature Group Holdings, LLC
|
Warrants
|
06/11/2012 |
06/11/2020 |
Common Stock
|
660,000
(1)
|
$
1.03
|
I
|
Signature Group Holdings, LLC
|
Warrants
|
06/11/2013 |
06/11/2020 |
Common Stock
|
660,000
(1)
|
$
1.03
|
I
|
Signature Group Holdings, LLC
|
Warrants
|
06/11/2014 |
06/11/2020 |
Common Stock
|
660,000
(1)
|
$
1.03
|
I
|
Signature Group Holdings, LLC
|
* |
If the form is filed by more than one reporting person, see Instruction 5(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 June 11, 2010, Signature Group Holdings, LLC was issued 8,800,000 Warrants for $.02 per warrant share to purchase common shares in Signature Group Holdings, Inc. (SGGH.PK) at $1.03 per share. The Warrants vest as to shares of the underlying common stock as follows: 20% on the Effective Date June 11, 2010, and 20% each year in annual installments thereafter until the Warrants are fully vested on the fourth anniversary of the Effective Date. The amounts disclosed represent Mr. Ross's 37.5% benefical ownership share of Signature Group Holdings, LLC. |