Statement of Changes in Beneficial Ownership (4)
November 12 2021 - 5:13PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Lee Steven B. |
2. Issuer Name and Ticker or Trading Symbol
Trean Insurance Group, Inc.
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TIG
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O TREAN INSURANCE GROUP, INC., 150 LAKE STREET WEST |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/9/2021 |
(Street)
WAYZATA, MN 55391
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 10/8/2021 | | G |
V
| 170000 (1) | D | $0.00 | 58750 | D | |
Common Stock | 11/9/2021 | | A | | 2485 | A | $0.00 | 61235 | D | |
Common Stock | | | | | | | | 881016 | I | As trustee (2) |
Common Stock | | | | | | | | 97935 | I | As trustee (3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Explanation of Responses: |
(1) | On October 8, 2021, Mr. Lee transferred 170,000 shares of TIG common stock from his direct ownership to the Lee 2020 GST Dynasty Trust, of which Mr. Lee is the investment trustee. This number includes 135,000 shares previously held by the Steven B. Lee 2020 GRAT that were transferred to Mr. Lee's direct ownership immediately before this transaction. |
(2) | Held by the Lee 2020 GST Dynasty Trust, of which Mr. Lee is investment trustee. |
(3) | Held by the Steven B. Lee 2020 GRAT, of which Mr. Lee is trustee. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Lee Steven B. C/O TREAN INSURANCE GROUP, INC. 150 LAKE STREET WEST WAYZATA, MN 55391 | X |
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Signatures
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/s/ Patricia A. Ryan, attorney-in-fact | | 11/12/2021 |
**Signature of Reporting Person | Date |
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