SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person* PBRA, LLC (Last) (First) (Middle) C/O PINE BROOK ROAD PARTNERS, LLC 60 EAST 42ND STREET, 50TH FLOOR (Street) NEW YORK NY 10165 (City) (State) (Zip)	2. Date of Event Requiring Statement (Month/Day/Year) 05/08/2018	3. Issuer Name and Ticker or Trading Symbol Origin Bancorp, Inc. [ OBNK ]
		4. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director X 10% Owner Officer (give title below) Other (specify below)	5. If Amendment, Date of Original Filed (Month/Day/Year)
			6. Individual or Joint/Group Filing (Check Applicable Line) Form filed by One Reporting Person X Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock, par value $5.00 per share	1,803,285	I	See Footnotes(1)(2)(3)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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: 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
Series D Preferred Stock, no par value	(4)	(5)	Common Stock	901,644	(2)(3)	I	See Footnote(1)

1. Name and Address of Reporting Person* PBRA, LLC (Last) (First) (Middle) C/O PINE BROOK ROAD PARTNERS, LLC 60 EAST 42ND STREET, 50TH FLOOR (Street) NEW YORK NY 10165 (City) (State) (Zip) Relationship of Reporting Person(s) to Issuer Director X 10% Owner Officer (give title below) Other (specify below)

1. Name and Address of Reporting Person* PINE BROOK CAPITAL PARTNERS LP (Last) (First) (Middle) C/O PINE BROOK ROAD PARTNERS, LLC 60 EAST 42ND STREET, 50TH FLOOR (Street) NEW YORK NY 10165 (City) (State) (Zip) Relationship of Reporting Person(s) to Issuer Director X 10% Owner Officer (give title below) Other (specify below)

1. Name and Address of Reporting Person* NEWMAN HOWARD H (Last) (First) (Middle) C/O PINE BROOK ROAD PARTNERS, LLC 60 EAST 42ND STREET, 50TH FLOOR (Street) NEW YORK NY 10165 (City) (State) (Zip) Relationship of Reporting Person(s) to Issuer Director X 10% Owner Officer (give title below) Other (specify below)

1. Name and Address of Reporting Person* Pine Brook Road Associates, L.P. (Last) (First) (Middle) C/O PINE BROOK ROAD PARTNERS, LLC 60 EAST 42ND STREET, 50TH FLOOR (Street) NEW YORK NY 10165 (City) (State) (Zip) Relationship of Reporting Person(s) to Issuer Director X 10% Owner Officer (give title below) Other (specify below)

Explanation of Responses:

1. This Form 3 is being filed on behalf of Pine Brook Capital Partners, L.P., a Delaware limited partnership, Pine Brook Road Associates, L.P., a Delaware limited partnership and the general partner of Pine Brook Capital Partners, L.P., PBRA, LLC, a Delaware single-member limited liability company that controls Pine Brook Road Associates, L.P. in its capacity as general partner, and Howard Newman, the sole member of PBRA, LLC. Mr. Newman has investment and voting control over the shares held or controlled by the Pine Brook Funds (as defined below).

2. Reflects 1,446,821 shares of Common Stock held by Pine Brook Capital Partners, L.P., 255,421 shares of Common Stock held by Pine Brook Capital Partners (SSP Offshore) II, L.P and 101,043 shares of Common Stock held by Pine Brook Capital Partners (Cayman), L.P. (collectively, the "Pine Brook Funds"). Pine Brook Road Associates, L.P. is the general partner of each of the Pine Brook Funds.

3. Howard Newman, PBRA, LLC, Pine Brook Road Associates, L.P. and Pine Brook Capital Partners, L.P. each disclaims beneficial ownership of the securities reported herein, except to the extent of its pecuniary interest therein, if any. Pursuant to Rule 16a-1(a)(4) under the Securities Exchange Act of 1934, the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of all of the reported securities by any reporting person for purposes of Section 16 or for any other purpose.

4. The Series D Preferred Stock is convertible, on a one-for-one basis, into shares of common stock at the discretion of the Pine Brook Funds or the issuer, to the extent that the holder of the Series D Preferred Stock would not, with its affiliates, own more than 9.99% of the issuer's outstanding common stock, or any class of voting securities, following such conversion.

5. The Series D Preferred Stock is subject to mandatory conversion upon the transfer of any shares of Series D Preferred Stock to a holder that is not an affiliate of the Pine Brook Funds.

Remarks:

	By: PBRA, LLC; By: /s/ Oliver Goldstein, Executive Vice President	05/08/2018
	By: Pine Brook Capital Partners, L.P.; By: Pine Brook Road Associates, L.P., its General Partner; By: PBRA, LLC, its General Partner; By: /s/ Oliver Goldstein, Executive Vice President	05/08/2018
	/s/ Howard Newman	05/08/2018
	By: Pine Brook Road Associates, L.P.; By: PBRA, LLC, its General Partner; By: /s/ Oliver Goldstein, Executive Vice President	05/08/2018
	** Signature of Reporting Person	Date
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