FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Doma Holdings, Inc. [ DOMA ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 02/27/2023 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common stock | 02/27/2023 | G | 346,609(1) | D | $0 | 0(2) | I | By Jennifer Saslaw 2020 GRAT | ||
Common stock | 02/27/2023 | G | 346,609(1) | D | $0 | 0(3) | I | By Max Simkoff 2020 GRAT | ||
Common stock | 02/27/2023 | G | 693,218(1) | A | $0 | 46,445,530(4) | I | By The Saslaw-Simkoff Revocable Trust | ||
Common stock | 02/27/2023 | G | 1,411,776(5) | D | $0 | 45,033,754(4) | I | By The Saslaw-Simkoff Revocable Trust | ||
Common stock | 02/27/2023 | G | 705,888(5) | A | $0 | 705,888(2) | I | By Jennifer Saslaw 2023 GRAT | ||
Common stock | 02/27/2023 | G | 705,888(5) | A | $0 | 705,888(6) | I | By Maxwell Simkoff 2023 GRAT | ||
Common stock | 5,219,014 | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. 346,609 shares of Doma Holdings, Inc. (the "Company") common stock were previously owned by each of the Jennifer Saslaw 2020 GRAT and the Max Simkoff 2020 GRAT. These shares were distributed in the form of an annuity payment pursuant to the terms of the GRATS and subsequently transferred to The Saslaw-Simkoff Revocable Trust for no consideration. |
2. These shares are held for the benefit of the reporting person's wife. The reporting person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
3. These shares are owned directly by the Max Simkoff 2020 GRAT. The reporting person disclaims beneficial ownership except to the extent of his pecuniary interest therein. |
4. These shares are owned directly by The Saslaw-Simkoff Revocable Trust and indirectly by Maxwell Simkoff as trustee of the trust. The reporting person disclaims beneficial ownership except to the extent of his pecuniary interest therein. |
5. 1,411,776 shares of Company common stock previously owned by The Saslaw-Simkoff Revocable Trust were contributed as follows: 705,888 shares were transferred to each of the Jennifer Saslaw 2023 GRAT and the Maxwell Simkoff 2023 GRAT for no consideration. |
6. These shares are owned directly by the Maxwell Simkoff 2023 GRAT. The reporting person disclaims beneficial ownership except to the extent of his pecuniary interest therein. |
Remarks: |
/s/ Christian Ameri, as Attorney-in-Fact for Maxwell Simkoff | 02/28/2023 | |
/s/ Christian Ameri, as Attorney-in-Fact for Maxwell Simkoff, Trustee | 02/28/2023 | |
** Signature of Reporting Person | Date | |
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). | ||
** 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. | ||
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 Number. |