1
|
NAME
OF REPORTING PERSON:
|
|
Michael
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
|
|
1,350,000
|
|
Owned
by
|
8
|
SHARED
VOTING POWER:
|
|
Each
|
|||
Trustee
|
|
9,392,600
(1)
|
|
With:
|
9
|
SOLE
DISPOSITIVE POWER:
|
|
|
1,350,000
|
||
10
|
SHARED
DISPOSITIVE POWER:
|
||
|
|
9,392,600
(1)
|
11
|
AGGREGATE
AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON:
|
|
|
10,742,600
(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):
|
|
|
15.0%
(1)
|
|
14
|
TYPE
OF REPORTING PERSON (See Instructions):
|
|
|
IN
|
(1)
|
The
Reporting Person disclaims beneficial ownership of 3,892,130 of these
shares held by the HOD Foundation.
|
(a)
|
As
of January 20, 2009, the Reporting Person beneficially owned 6,850,470
Common Shares as follows: (i) warrants to purchase 1,350,000 Common Shares
held directly by the Reporting Person and (ii) 5,500,470 Common Shares
held indirectly by the Reporting Person as a trustee of the
Trust. The Reporting Person disclaims beneficial ownership of
the 3,892,130 Common Shares that he holds indirectly as a trustee of
HOD.
|
(b)
|
As
of January 20, 2009, the Reporting Person had sole voting and dispositive
power with respect to (i) 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, (ii) the 3,892,130 Common Shares held indirectly by
the Reporting Person as a trustee of HOD, and (iii) the
5,500,470 Common Shares held indirectly by the Reporting Person as a
trustee of the Trust.
|
(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 Michael 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 Michael Karfunkel 2005
Grantor Retained Annuity Trust 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).
|
MICHAEL
KARFUNKEL
|
|||
|
By:
|
/s/ Michael 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 filed on September 17, 2007).
|
Exhibit
B
|
Warrant
granted by Maiden Holdings, Ltd. to Michael 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 Michael Karfunkel 2005
Grantor Retained Annuity Trust 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).
|