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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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(f) of the Investment Company Act of 1940
[ ] Check this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
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1. Name and Address of Reporting Person*
BLAKE Victor H.
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(Last) (First) (Middle)
c/o LaSalle Re Holdings Limited
25 Church Street
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(Street)
Hamilton HM FX BERMUDA
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
LaSalle Re Holdings Limited (NYSE: LSH)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
September 1998
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ x ] Director [ ] 10% Owner
[ x ] Officer (give title below) [ ] Other (specify below)
Chairman, President and Chief Executive Officer
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7. Individual or Joint/Group Filing
(Check applicable line)
[ x ] Form filed by one Reporting Person
[ ] Form filed by more than one Reporting Person
<PAGE>
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. ----------------------------- of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (Instr. 8) (D) & 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
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Common Shares 10/3/97 A(1) 222 A $35.125
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Common Shares 10/16/97 A(1) 5,806 A $35.125
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Common Shares 10/17/97 A(2) 4.527 A $34.813
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Common Shares 1/6/98 A(1) 195.473 A $30.069
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Common Shares 3/20/98 A(3) 16,339.626 A (3)
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Common Shares 4/3/98 A(1) 202 A $35.647
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Common Shares 6/19/98 A(3) 3,918.369 A (3)
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Common Shares 7/3/98 A(1) 193 A $32.194
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Common Shares 9/18/98 A(3) 565.339 A (3) 66,456.334 D
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===================================================================================================================================
</TABLE>
* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Page 1 of 2
<PAGE>
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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Common
Options to acquire $16.58 3/20/98 D(4) 85,218 (5) 11/27/2005 Shares 85,218 -0- D
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Common
Options to acquire $19.25 3/20/98 A(4) 85,218 (5) 11/27/2005 Shares 85,218 85,218 D
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Common
Options to acquire $26.58 3/20/98 D(4) 85,218 (6) 5/19/2007 Shares 85,218 -0- D
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Common
Options to acquire $28.75 3/20/98 A(4) 85,218 (6) 5/19/2007 Shares 85,218 85,218 D
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Explanation of Responses:
(1) Purchase pursuant to the LaSalle Re Holdings Limited Employee Stock Purchase Plan.
(2) Under an anti-dilution provision which became effective on March 20, 1998, holders of options ("Options") granted under
the LaSalle Re Holdings Limited 1996 Long-Term Incentive Plan (the "Plan") receive awards of restricted stock under the
Plan to compensate for the dilutive effect of certain dividends paid by the Issuer. The awards of restricted stock vest
only when the underlying Options are exercised.
(3) The anti-dilution provision described in Note (3) superseded a prior provision which compensated for the dilutive effect
of certain dividends paid by the Issuer by reducing the exercise price of the Options. The new anti-dilution provision
was designed to provide the same economic benefit to holders of Options as the prior provision. However, in accordance
with published views of the Commission staff, the implementation of the new provision is reported, solely for purposes
of the Section 16 reporting obligation, as the surrender of an existing Option followed by the grant of a new Option.
(4) Options vest as follows: 1/5 on 11/27/96, 1/5 on 11/27/97, 1/5 on 11/27/98, 1/5 on 11/27/99 and 1/5 on 11/27/2000.
(5) Options vest as follows: 1/3 on 5/19/98, 1/3 on 5/19/99 and 1/3 on 5/19/2000.
</TABLE>
/s/ Victor H. Blake November 12, 1998
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**Signature of Reporting Person Date
** 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 provided is insufficient, see Instruction 6 for procedure.
Alternatively, this Form is permitted to be submitted to the Commission in
electronic format at the option of the reporting person pursuant to Rule
101(b)(4) of Regulation S-T.
Page 2 of 2
(122795DTI)
