Statement of Changes in Beneficial Ownership (4)
19 November 2021 - 9:31AM
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
*
Millette Michael |
2. Issuer Name and Ticker or Trading Symbol
Kairos Acquisition Corp.
[
KAIR
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) __X__ Other (specify below) Board Observer |
(Last)
(First)
(Middle)
C/O HUDSON STRUCTURED CAPITAL MGMT LTD., 2187 ATLANTIC STREET - 4TH FLOOR |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/16/2021 |
(Street)
STAMFORD, CT 06902
(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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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 |
Class B Ordinary Shares | (1) | 11/16/2021 | | P | | 15000 | | (1) | (1) | Class A Ordinary Shares | 15000 | $0 | 3959894 | I | See Footnote (2) |
Explanation of Responses: |
(1) | As described in the registrant's registration statement on Form S-1 (File No. 333-251553) under the heading "Description of Securities - Founder Shares", the Class B ordinary shares will automatically convert into Class A ordinary shares at the time of the registrant's initial business combination on a one-for-one basis (unless otherwise provided in the registrant's initial business combination agreement), subject to adjustment for share subdivisions, share consolidations, share capitalizations, reorganizations, recapitalizations and the like, and certain anti-dilution rights and have no expiration date. |
(2) | Vikas Singhal, a Director of the issuer, and Michael Millette, the board observer of the issuer, are the Partners of Hudson Structured Capital Management Ltd. ("HSCM") which manages HSCM Bermuda Fund Ltd. ("HSCM Fund One") and HS Santanoni LP ("HSCM Fund Two"). HSCM Fund One and HSCM Fund Two jointly own HS Chronos LLC, of which Messrs. Singhal and Millette also serve as officers. Therefore, Messrs. Singhal and Millette manage, directly or indirectly, each of HS Chronos LLC, HSCM Fund One, HSCM Fund Two and HSCM (collectively, the "HSCM Holders"), and therefore may be deemed to be the beneficial owners of all the ordinary shares beneficially owned by the HSCM Holders. Messrs. Singhal and Millette, HSCM Fund One, HSCM Fund Two and HSCM disclaim beneficial ownership of the ordinary shares except to the extent of their respective pecuniary interests therein. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Millette Michael C/O HUDSON STRUCTURED CAPITAL MGMT LTD. 2187 ATLANTIC STREET - 4TH FLOOR STAMFORD, CT 06902 |
| X |
| Board Observer |
Signatures
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/s/ Michael Millette | | 11/18/2021 |
**Signature of Reporting Person | Date |
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