12-26-12 Form 4 - Kingsway Financial Services Inc.

SEC FORM 4
Page 1 of 1
SEC Form 4
UNITED STATES SECURITIES AND EXCHANGE
COMMISSION
FORM 4
OMB APPROVAL
OMB Number:
Washington, D.C. 20549
3235-0287
December 31,
2014
Expires:
Check this box if no longer subject
to Section 16. Form 4 or Form 5
obligations may continue. See
Instruction 1(b).
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
2. Issuer Name and Ticker or Trading Symbol
Kavanagh Terence Michael
KINGSWAY FINANCIAL SERVICES
INC [ KFS ]
(First)
hours per
response:
0.5
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
1. Name and Address of Reporting Person*
(Last)
Estimated average burden
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X
(Middle)
OAKMONT CAPITAL INC.
45 ST. CLAIR AVENUE WEST, SUITE 400
M4V 1K9
(City)
(State)
(Zip)
Other (specify
below)
3. Date of Earliest Transaction (Month/Day/Year)
4. If Amendment, Date of Original Filed (Month/Day/Year)
A6
10% Owner
Officer (give title
below)
12/21/2012
6. Individual or Joint/Group Filing (Check
Applicable Line)
(Street)
TORONTO
Director
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
2. Transaction
Date
(Month/Day/Year)
1. Title of Security (Instr. 3)
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)
Code
Amount
V
Common Stock
12/21/2012
P
50
Common Stock
12/21/2012
P
2,550
(A)
or
(D)
Price
A $3.37
5. Amount of
Securities
Beneficially
Owned
Following
Reported
Transaction
(s) (Instr. 3
and 4)
6.
Ownership
Form:
Direct (D)
or Indirect
(I) (Instr. 4)
536,375
I
By
Oakmont
Capital
Inc.
I
By
Oakmont
Capital
Inc.
(1)
A $3.32 538,925
(2)
7. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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)
Code
V
5.
Number
of
Derivative
Securities
Acquired
(A) or
Disposed
of (D)
(Instr. 3, 4
and 5)
(A)
(D)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)
Date
Exercisable
Expiration
Date
7. Title and
Amount of
Securities
Underlying
Derivative
Security
(Instr. 3 and 4)
Title
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)
Amount
or
Number
of
Shares
Explanation of Responses:
1. Total reflects four-for-one share consolidation effected by the Company on July 3, 2012.
2. Terence Michael Kavanagh, directly owns shares of common stock (1,750) and indirectly through Retirement Savings Plan (26,875 shares), E.J.K. Holdings, Inc. (6,000 shares), in trust for W.
Aikman (125 shares), and Oakmont Capital Inc. (504,175 shares).
Ninette Voiles, by power of
12/26/2012
attorney
** 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.
http://www.sec.gov/Archives/edgar/data/1072627/000107262712000098/xslF345X03/pri...
2/11/2013