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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | 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 control number. | SEC 2270 (9-02) |
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 Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DEEKS MONICA C/O THE NAVIGATORS GROUP, INC. 400 ATLANTIC STAMFORD, CT 06901 |
 |  X |  |  |
/s/ Deepa R. Nayini, attorney-in-fact | 02/13/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Represents distribution in kind to Terence N. Deeks by the Terence N. Deeks 2013 Qualified Three Year Annuity Trust (the "2013Trust"), of which the Reporting Person was trustee. |
(2) | Includes 2,631,826 shares held by the Trusts as of December 31, 2016, 56,400 shares owned jointly with the Reporting Person's husband, Terence N. Deeks, and 51,000 shares held by the Deeks Family Foundation (the "Foundation"). Includes 975,898 shares held by the Reporting Person's spouse directly. The Reporting Person disclaims beneficial ownership of the shares held by the Trusts and the Foundation except to the extent of any pecuniary interest she may be deemed to hold therein. |
(3) | Represents distribution in kind by the 2013 Trust to trusts for the benefit of Reporting Person's children or grandchildren. |
(4) | Represents gift by the Reporting Person to the Terence N. Deeks 2016 Qualified Three Year Annuity Trust (the "2016 Trust"), of which the Reporting Person is trustee. |
(5) | Represents a gift to the Deeks Family Foundation (the "Foundation"). |
(6) | Represents distribution in kind to Terence N. Deeks by the Terence N. Deeks 2014 Qualified Three Year Annuity Trust (the "2014 Trust"), of which the Reporting Person is trustee. |
(7) | Represents distribution in kind to Terence N. Deeks by the Terence N. Deeks 2015 Qualified Three Year Annuity Trust (the "2015 Trust"), of which the Reporting Person is trustee. |
(8) | Represents distribution in kind to the 2016 Trust, of which the Reporting Person is trustee. |
(9) | On December 6, 2016, the Board of Directors of the Issuer declared a stock dividend, payable to all holders of record of common stock on December 30, 2016, of one share of common stock for each share of common stock outstanding. As a result, the reported amount of securities beneficially owned includes 1,857,562 shares that the Reporting Person received on January 20, 2017. |