1
|
NAME
OF REPORTING PERSON:
|
|
George
Karfunkel
|
||
SS
OR IRS IDENTIFICATION NOS. OF ABOVE PERSONS: NA
|
||
2
|
CHECK
THE APPROPRIATE BOX IF A MEMBER OF GROUP (See
Instructions)
|
|
(a)
o
|
||
|
(b)
o
|
|
3
|
SEC
USE ONLY
|
|
|
|
|
4
|
SOURCE
OF FUNDS:
|
|
PF
|
||
5
|
CHECK BOX IF DISCLOSURE OF LEGAL
PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) OR
2(e)
|
|
o
|
||
6
|
CITIZENSHIP
OR PLACE OF ORGANIZATION:
|
|
United
States of America
|
Number
of
|
7
|
SOLE
VOTING POWER:
|
|
Shares
|
|||
Beneficially
|
|
3,208,547
|
|
Owned
by
|
8
|
SHARED
VOTING POWER:
|
|
Each
|
|||
Trustee
|
|
4,338,483
(1)
|
|
With:
|
9
|
SOLE
DISPOSITIVE POWER:
|
|
|
3,208,547
|
||
10
|
SHARED
DISPOSITIVE POWER:
|
||
|
|
4,338,483
(1)
|
11
|
AGGREGATE
AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON:
|
|
|
7,547,030
(1)
|
|
12
|
CHECK
IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDE CERTAIN SHARES (See
Instructions)
|
|
|
o
|
|
13
|
PERCENT
OF CLASS REPRESENTED BY AMOUNT IN ROW (11):
|
|
|
10.5%
(1)
|
|
14
|
TYPE
OF REPORTING PERSON (See Instructions):
|
|
|
IN
|
(1)
|
The
Reporting Person disclaims beneficial ownership of 741,453 of these shares
held by the Chesed Foundation.
|
(a)
|
As
of January 20, 2009, the Reporting Person beneficially owned 6,805,577
Common Shares as follows: (i) the 1,858,547 Common Shares held directly by
the Reporting Person, (ii) warrants to purchase 1,350,000 Common Shares
held directly by the Reporting Person and (iii) 3,597,030 Common Shares
held indirectly by the Trusts of which the Reporting Person is a
beneficiary. The Reporting Person disclaims beneficial
ownership of the 741,453 Common Shares that he holds indirectly as a
Trustee of the Chesed Foundation (“Chesed”), a charitable foundation
organized by the Reporting Person.
|
(b)
|
As
of January 20, 2009, the Reporting Person had sole voting and dispositive
power with respect to (i) the 1,858,547 Common Shares held directly by the
Reporting Person, (ii) assuming exercise of the warrants at the discretion
of the Reporting Person, the 1,350,000 Common Shares issuable upon the
exercise of warrants to purchase Common Shares held directly by the
Reporting Person, (iii) the 741,453 Common Shares held indirectly by the
Reporting Person as a Trustee of Chesed, and (iv) the 3,597,030
Common Shares held indirectly by the Reporting Person as a
beneficiary of the Trusts.
|
(c)
|
Except
for the transactions described in Item 3, the Reporting Person has not had
any other transactions in the Common Shares that were effected during the
past 60 days.
|
(d)
|
Not
applicable.
|
(e)
|
Not
applicable.
|
Exhibit
A
|
Registration
Rights Agreement between Maiden Holdings, Ltd., Barry D. Zyskind, George
Karfunkel and Michael Karfunkel dated as of July 3, 2007 (incorporated by
reference to Exhibit 4.6 to the Registration Statement on Form
S-1 filed on September 17, 2007).
|
Exhibit
B
|
Warrant
granted by Maiden Holdings, Ltd. to George Karfunkel, effective June 14,
2007 (incorporated by reference to Exhibit 4.3 to the Registration
Statement on Form S-1 filed on September 17, 2007).
|
Exhibit
C
|
Purchase
Agreement between Maiden Holdings, Ltd., the George Karfunkel 2007 Grantor
Retained Annuity Trust #1, the George Karfunkel 2007 Grantor Retained
Annuity Trust #2, and other investors, dated as of January 20, 2009
(incorporated by reference to Exhibit 10.1 to the Current Report on Form
8-K filed on January 26, 2009).
|
GEORGE
KARFUNKEL
|
|||
|
By:
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/s/ George Karfunkel | |
Exhibit
A
|
Registration
Rights Agreement between Maiden Holdings, Ltd., Barry D. Zyskind, George
Karfunkel and Michael Karfunkel dated as of July 3, 2007 (incorporated by
reference to Exhibit 4.6 to the Registration Statement on Form
S-1 of Maiden Holdings, Ltd. filed on September 17,
2007).
|
Exhibit
B
|
Warrant
granted by Maiden Holdings, Ltd. to George Karfunkel, effective June 14,
2007 (incorporated by reference to Exhibit 4.3 to the Registration
Statement on Form S-1 of Maiden Holdings, Ltd. filed on September 17,
2007).
|
Exhibit
C
|
Purchase
Agreement between Maiden Holdings, Ltd., the George Karfunkel 2007 Grantor
Retained Annuity Trust #1, the George Karfunkel 2007 Grantor Retained
Annuity Trust #2, and other investors, dated as of January 20, 2009
(incorporated by reference to Exhibit 10.1 to the Current Report on Form
8-K filed on January 26, 2009).
|