-----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, V8qFAAC5GSWrjC3dxYOkFWvdLZNQMif4BD6fmHRcUFLzjljOMolupJd0HKu3Lpgq /h6RxfXWjjncVSoB2kkf7g== 0000902561-02-000496.txt : 20021018 0000902561-02-000496.hdr.sgml : 20021018 20021018164505 ACCESSION NUMBER: 0000902561-02-000496 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020404 FILED AS OF DATE: 20021018 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: MARINER PARTNERS INC CENTRAL INDEX KEY: 0001168360 RELATIONSHIP: OWNER STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 780 THIRD AVENUE CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 2127586200 MAIL ADDRESS: STREET 1: 780 THIRD AVENUE CITY: NEW YORK STATE: NY ZIP: 10017 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: NYMAGIC INC CENTRAL INDEX KEY: 0000847431 STANDARD INDUSTRIAL CLASSIFICATION: SURETY INSURANCE [6351] IRS NUMBER: 133534162 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-11238 FILM NUMBER: 02792934 BUSINESS ADDRESS: STREET 1: 330 MADISON AVE CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 2125510600 MAIL ADDRESS: STREET 1: 330 MADISON AVE CITY: NEW YORK STATE: NY ZIP: 10017 4 1 marin4.txt | OMB APPROVAL | | | | OMB Number: 3235-0287 | | Expires: January 31, 2005 | | Estimated average burden | FORM 4 | hours per response......0.5 | U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 [_] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) - ------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Mariner Partners, Inc. - ------------------------------------------------------------------------------- (Last) (First) (Middle) 780 Third Avenue 16th Floor - ------------------------------------------------------------------------------- (Street) New York, NY 10017 - ------------------------------------------------------------------------------- (City) (State) (Zip) - ------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol NYMAGIC, INC. ("NYM") - ------------------------------------------------------------------------------- 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) - ------------------------------------------------------------------------------- 4. Statement for Month/Day/Year 4/4/02 - ------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Day/Year) - ------------------------------------------------------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify title below) ---------------------------------------- - ------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) [X] Form filed by One Reporting Person [_] Form filed by More than One Reporting Person - -------------------------------------------------------------------------------
=================================================================================================================================== Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned =================================================================================================================================== 5. Amount of 6. 4. Securities Owner- 2A. 3. Securities Acquired (A) Beneficially ship 2. Deemed Trans- or Disposed of (D) Owned Form: 7. Trans- Execution action (Instr. 3, 4 and 5) Following Direct Nature of action Date, Code ------------------------ Reported (D) or Indirect 1. Date if any (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security (Month/ (Month/ ---------- or (Instr. 3 (I) Ownership (Instr. 3) Day/Year) Day/Year) Code V Amount (D) Price and 4) (Instr.4) (Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- =================================================================================================================================== Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 4(b)(v). Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number (Over) SEC 1474 (9-02)
FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ==================================================================================================================================== 9. 10. Number Owner- of ship deriv- Form 2. ative of Conver- 5. 7. Secur- Deriv- 11. sion Number of Title and Amount ities ative Nature or 3A. Derivative 6. of Underlying 8. Bene- Secur- of Exer- Deemed 4. Securities Date Securities Price ficially ity In- cise 3. Execu- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Owned Direct direct Price Trans- tion action or Disposed Expiration Date ---------------- Deriv- Following (D) or Bene- 1. of action Date, Code of (D) (Month/Day/Year) Amount ative Reported In- ficial Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity action(s) (I) ship Security Secur- Day/ Day/ ------- ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Options to (1) 4/4/02 J(4) 315,000 2/20/02 (3) Common 315,000 Purchase (2) Stock - ------------------------------------------------------------------------------------------------------------------------------------ Options to (1) 4/4/02 J(4) 315,000 2/20/03 (3) Common 315,000 1,170,000 D Purchase (2) Stock - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== Explanation of Responses: (1) The option exercise price ranges from $19.00 per share to $22.00 per share,depending on the date of purchase. (2) It was reported on Form 3 that the aggregated options held by the reporting person could not be exercised in an amount which represented 10% or more of all of the voting power of NYMAGIC, Inc. ("NYMAGIC") until the New York Superintendent of Insurance approved the options or determined that no such approval was necessary. Such approval was granted on July 31, 2002; therefore all options are now exercisable. (3) The options were granted pursuant to a voting agreement (the "Voting Agreement") dated as of February 20, 2002 among the reporting person and certain shareholders of NYMAGIC. The option expires 30 days after the termination of the Voting Agreement. The termination date of the Voting Agreement is the first to occur of ((i) February 15, 2005, (ii) the merger, consolidation sale of substantially all assets, dissolution or liquidation of NYMAGIC, (iii) the resignation of the reporting person, or (iv) termination of the reporting person by the other parties to the Voting Agreement under the circumstances specified in the Voting Agreement. (4) Option for 315,000 shares were assigned by the reporting person to each of A. George Kallop and William D. Shaw, Jr., in each case in consideration for services provided to the reporting person in connection with NYMAGIC.
MARINER PARTNERS, INC. /s/ William J. Michaelcheck 10/15/02 ------------------------------------------ ----------------------- **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2 -----END PRIVACY-ENHANCED MESSAGE-----