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If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) |
As of the date of this Form 3, Ms. Ong has no direct or indirect beneficial interests in any security of Employers Holdings, Inc. (the "Company"). Ms. Ong is a director of Hobbs, Ong & Associates, Inc., a Las Vegas accounting firm, which holds a policy issued by Employers Insurance Company of Nevada, an indirect wholly-owned subsidiary of the Company. The policy owned by Hobbs, Ong & Associates, Inc. entitles it to receive consideration consisting of an estimated 732 shares of common stock (assuming no exercise of the over-allotment option granted by the Company to the underwriters) as a result of the conversion of the Company from a Nevada mutual insurance company owned by its members to a Nevada stock corporation. If the over-allotment option is exercised, Hobbs, Ong & Associates, Inc.'s entitlement to consideration in the conversion will change. |
(2) |
By virtue of her ownership interests in Hobbs, Ong & Associates, Inc., Ms. Ong may be deemed to beneficially own any shares listed as beneficially owned by Hobbs, Ong & Associates, Inc. Ms. Ong will disclaim beneficial ownership of such shares except to the extent of her pecuniary interests therein and the inclusion of the shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose. |