-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, VXlMBNGN/nm23f48oN7d3KM8Y+FeY85xSYblSfgQjHhDb0s41FKlrXc58q87/XR3 rruZlgCgXz6eqmLy3qDqXw== 0000950172-05-002908.txt : 20050831 0000950172-05-002908.hdr.sgml : 20050831 20050831153934 ACCESSION NUMBER: 0000950172-05-002908 CONFORMED SUBMISSION TYPE: SC 13D/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20050831 DATE AS OF CHANGE: 20050831 GROUP MEMBERS: ANDREW G. BLUHM GROUP MEMBERS: NEW AFFIRMATIVE LLC SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AFFIRMATIVE INSURANCE HOLDINGS INC CENTRAL INDEX KEY: 0001282543 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 752770432 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: SC 13D/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-79966 FILM NUMBER: 051061830 BUSINESS ADDRESS: STREET 1: 4450 SOJOURN DRIVE STREET 2: SUITE 500 CITY: ADDISON STATE: TX ZIP: 75001 BUSINESS PHONE: 972-728-6300 MAIL ADDRESS: STREET 1: 4450 SOJOURN DRIVE STREET 2: SUITE 500 CITY: ADDISON STATE: TX ZIP: 75001 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: DSC AFFM Manager, LLC CENTRAL INDEX KEY: 0001331434 IRS NUMBER: 203048271 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D/A BUSINESS ADDRESS: STREET 1: 900 N. MICHIGAN AVENUE STREET 2: SUITE 1900 CITY: CHICAGO STATE: IL ZIP: 60611 BUSINESS PHONE: 312-915-2400 MAIL ADDRESS: STREET 1: 900 N. MICHIGAN AVENUE STREET 2: SUITE 1900 CITY: CHICAGO STATE: IL ZIP: 60611 SC 13D/A 1 ny526518.txt AMENDMENT NO. 4 SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13D (Amendment No. 4) Under the Securities Exchange Act of 1934 AFFIRMATIVE INSURANCE HOLDINGS, INC. -------------------------------------------------------------------- (Name of Issuer) COMMON STOCK, PAR VALUE $.01 PER SHARE -------------------------------------------------------------------- (Title of Class of Securities) 008272106 -------------------------------------------------------------------- (CUSIP Number) Andrew G. Bluhm DSC AFFM Manager LLC 900 N. Michigan Avenue, Suite 1900 Chicago, Illinois 60611 Telephone: (312) 915-2400 Facsimile: (312) 915-2487 -------------------------------------------------------------------- (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) With a copy to: Thomas W. Greenberg, Esq. Skadden, Arps, Slate, Meagher & Flom LLP Four Times Square New York, New York 10036 (212) 735-3000 August 30, 2005 -------------------------------------------------------------------- (Date of Event Which Requires Filing of this Statement) If the filing person has previously filed a statement on Schedule 13G to report the acquisition that is the subject of this Schedule 13D, and is filing this schedule because of sections 240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following box. [ ] The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934, as amended (the "Exchange Act") or otherwise subject to the liabilities of that section of the Exchange Act but shall be subject to all other provisions of the Exchange Act (however, see the Notes). - ------------------------------------------------------------------------------- 1. Names of Reporting Persons. I.R.S. Identification Nos. of above persons (entities only) DSC AFFM Manager LLC - ------------------------------------------------------------------------------- 2. Check the Appropriate Box if a Member of a Group (See Instructions) (a) [X] (b) [ ] - ------------------------------------------------------------------------------- 3. SEC USE ONLY - ------------------------------------------------------------------------------- 4. Source of Funds (See Instructions) AF - ------------------------------------------------------------------------------- 5. Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e) [ ] - ------------------------------------------------------------------------------- 6. Citizenship or Place of Organization Delaware - ------------------------------------------------------------------------------- 7. Sole Voting Power 0 Number of ---------------------------------- Shares 8. Shared Voting Power Beneficially Owned by 7,860,927 (See Item 5) Each ---------------------------------- Reporting 9. Sole Dispositive Power Person with 0 ---------------------------------- 10. Shared Dispositive Power 7,860,927 (See Item 5) - ------------------------------------------------------------------------------- 11. Aggregate Amount Beneficially Owned by Each Reporting Person 7,860,927 (See Item 5) - -------- ----------------------------------------------------------------------- 12. Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions) [ ] - ------------------------------------------------------------------------------- 13. Percent of Class Represented by Amount in Row (11) 52.9% (See Item 5) - ------------------------------------------------------------------------------- 14. Type of Reporting Person (See Instructions) OO - ------------------------------------------------------------------------------- - ------------------------------------------------------------------------------- 1. Names of Reporting Persons. I.R.S. Identification Nos. of above persons (entities only) Andrew G. Bluhm - ------------------------------------------------------------------------------- 2. Check the Appropriate Box if a Member of a Group (See Instructions) (a) [X] (b) [ ] - ------------------------------------------------------------------------------- 3. SEC USE ONLY - ------------------------------------------------------------------------------- 4. Source of Funds (See Instructions) AF - ------------------------------------------------------------------------------- 5. Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e) [ ] - ------------------------------------------------------------------------------- 6. Citizenship or Place of Organization U.S. Citizen - ------------------------------------------------------------------------------- 7. Sole Voting Power 0 Number of ---------------------------------- Shares 8. Shared Voting Power Beneficially Owned by 7,860,927 (See Item 5) Each ---------------------------------- Reporting 9. Sole Dispositive Power Person with 0 ---------------------------------- 10. Shared Dispositive Power 7,860,927 (See Item 5) - ------------------------------------------------------------------------------- 11. Aggregate Amount Beneficially Owned by Each Reporting Person 7,860,927 (See Item 5) - ------------------------------------------------------------------------------- 12. Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions) [ ] - ------------------------------------------------------------------------------- 13. Percent of Class Represented by Amount in Row (11) 52.9% (See Item 5) - ------------------------------------------------------------------------------- 14. Type of Reporting Person (See Instructions) IN - ------------------------------------------------------------------------------- - ------------------------------------------------------------------------------- 1. Names of Reporting Persons. I.R.S. Identification Nos. of above persons (entities only) New Affirmative LLC - ------------------------------------------------------------------------------- 2. Check the Appropriate Box if a Member of a Group (See Instructions) (a) [X] (b) [ ] - ------------------------------------------------------------------------------- 3. SEC USE ONLY - ------------------------------------------------------------------------------- 4. Source of Funds (See Instructions) AF, OO - ------------------------------------------------------------------------------- 5. Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e) [ ] - ------- ----------------------------------------------------------------------- 6. Citizenship or Place of Organization Delaware - ------------------------------------------------------------------------------- 7. Sole Voting Power 0 Number of ---------------------------------- Shares 8. Shared Voting Power Beneficially Owned by 7,860,927 (See Item 5) Each ---------------------------------- Reporting 9. Sole Dispositive Power Person with 0 ---------------------------------- 10. Shared Dispositive Power 7,860,927 (See Item 5) - ------------------------------------------------------------------------------- 11. Aggregate Amount Beneficially Owned by Each Reporting Person 7,860,927 (See Item 5) - ------------------------------------------------------------------------------- 12. Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions) [ ] - ------------------------------------------------------------------------------- 13. Percent of Class Represented by Amount in Row (11) 52.9% (See Item 5) - ------------------------------------------------------------------------------- 14. Type of Reporting Person (See Instructions) OO - ------------------------------------------------------------------------------- This Statement on Schedule 13D/A (the "Statement") is being filed as Amendment No. 4 to the Statement on Schedule 13D originally filed with the Securities and Exchange Commission on June 13, 2005 (the "Original Statement"), as amended by Amendment No. 1 to the Statement on Schedule 13D filed with the Securities and Exchange Commission on June 14, 2005 (the "First Amendment"), Amendment No. 2 to the Statement on Schedule 13D filed with the Securities and Exchange Commission on June 30, 2005 (the "Second Amendment") and Amendment No. 3 to the Statement on Schedule 13D filed with the Securities and Exchange Commission on August 26, 2005 (the "Third Amendment"). Capitalized terms used but not defined herein have the meaning set forth in the Original Statement, the First Amendment, Second Amendment or the Third Amendment. Item 4. Purpose of Transaction. Item 4 is hereby supplementally amended as follows: On August 30, 2005, NAL consummated the transactions contemplated by the Vesta Stock Purchase Agreement. Item 5. Interest in Securities of the Issuer. Item 5(c) is hereby supplementally amended as follows: On August 30, 2005, pursuant to the Vesta Stock Purchase Agreement, NAL purchased 5,218,228 shares of Common Stock at $15.00 per share. As a result of the consummation of the Vesta Stock Purchase Agreement, the Reporting Persons beneficially own 7,860,927 shares of Common Stock. Item 7. Material to be Filed as Exhibits. Exhibit 1 Joint Filing Agreement, dated August 31, 2005, by and among the Reporting Persons SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth herein is true, complete and correct. DSC AFFM MANAGER LLC By: /s/ Andrew G. Bluhm --------------------------- Name: Andrew G. Bluhm Title: Authorized Person ANDREW G. BLUHM /s/ Andrew G. Bluhm --------------------------- NEW AFFIRMATIVE LLC By: /s/ Michael J. Ryan --------------------------- Name: Michael J. Ryan Title: Authorized Person By: /s/ Avshalom Kalichstein --------------------------- Name: Avshalom Kalichstein Title: Authorized Person Dated: August 31, 2005 Exhibit 1 JOINT FILING AGREEMENT In accordance with Rule 13d-1(k) under the Securities Exchange Act of 1934, as amended, the undersigned hereby agree to the joint filing on behalf of each of them of a statement on Schedule 13D (including amendments thereto) with respect to the Common Stock of Affirmative Insurance Holdings, Inc, and that this Agreement be included as an Exhibit to such joint filing. IN WITNESS WHEREOF, the undersigned hereby execute this Agreement this 31st day of August, 2005. DSC AFFM MANAGER LLC By: /s/ Andrew G. Bluhm ------------------------- Name: Andrew G. Bluhm Title: Authorized Person ANDREW G. BLUHM /s/ Andrew G. Bluhm - ----------------------------- NEW AFFIRMATIVE LLC By: /s/ Michael J. Ryan --------------------------- Name: Michael J. Ryan Title: Authorized Person By: /s/ Avshalom Kalichstein --------------------------- Name: Avshalom Kalichstein Title: Authorized Person -----END PRIVACY-ENHANCED MESSAGE-----