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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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
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FORM 5 OMB APPROVAL
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[ ] CHECK THIS BOX IF NO LONGER OMB Number: 3235-0362
SUBJECT TO SECTION 16. FORM 4 Expires: September 30, 1998
OR FORM 5 OBLIGATIONS MAY Estimated average burden
CONTINUE. SEE INSTRUCTION 1(B). hours per response .... 1.0
[ ] FORM 3 HOLDINGS REPORTED
[ ] FORM 4 TRANSACTIONS REPORTED
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1. Name and Address of Reporting Person *
Ivy Madie
(Last) (First) (Middle)
1330 Avenue of the Americas
(Street)
New York NY 10019
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ESG Re Limited (ESREF)
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Statement of Month/Year
12/98
5. If Amendment, Date or Original (Month/Year)
6. Relationship of Reporting Person to Issuer (Check all applicable)
Director X 10% Owner
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Officer (give title Other
----- below) ----- (specify
below)
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7. Individual or Join/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
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Form filed by More than One Reporting Person
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TABLE I-- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
1. Title of Security 2. Transaction 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
(Instr. 3) Date action or Disposed of (D) Securities ship of In-
Code (Instr. 3, 4 and 5) Beneficially Form: direct
(Month/ (Instr. 8) Owned at Direct Bene-
Day/ ------------- ------------------------- End of (D) ficial
Year) (A) Month Indirect Owner-
Code Amount or Price (Instr. 3 (I) ship
(D) and 4) (Instr. 4) (Instr. 4)
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(Over)
* If the form is filed by more than one reporting person, SEE Instruction 4(b)(v). SEC 1474 9-96)
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FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- 6. Date Exer-
Security (Instr. 3) sion or action tion Code ative Securities Ac- cisable and Ex-
Exercise Date (Instr. 8) quired (A) or Dis- piration Date
Price of posed of (D)
Deriv- (Month/ (Instr. 3, 4 and 5) (Month/Day/
ative Day/ Year)
Secur Year) ------------- ------------------------- ----------------------
Code (A) (D) Date Expira-
Exer- tion
cisable Date
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Options to buy $20/sh 12/12/97 G 17,857 12/12/97 12/12/07
Options to buy 1 $25.50/sh 5/4/98 G 15,357 5/4/98 5/4/08
Options to buy $20/sh 12/12/97 G 17,857 12/12/97 12/12/07
Options to buy 1 $25.50/sh 5/4/98 G 15,357 5/4/98 5/4/08
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7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na-
Underlying Securities Deriv of Deriv- ship ture
ative ative Form of In-
(Instr. 3 and 4) Secur- Secur- of De- direct
ity ities rivative Bene-
(Instr. Bene Secu- ficial
5) ficially rity: Own-
Owned Direct ership
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Amount or of Indi-
Title Number of Month rect (I)
Shares (Instr. 4) (Instr. 4)
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Common Shares 17,857 17,857 (I) (2)
Common Shares 15,357 15,357 (I) (2)
Common Shares 17,857 17,857 (I) (2)
Common Shares 15,357 15,357 (I) (2)
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Explanation of Responses:
1 These options were voluntarily reported on the reporting person's Form 4
statement for the month of October 1998; however, the exercise price of the
options was incorrectly reported as $20.50/share (rather than $25.50/share)
and the exercise date was incorrectly reported as 5/27/98 (rather than
5/4/98).
2 Options gifted to trust for the benefit of the heirs of Madie Ivy. The
reporting person disclaims beneficial ownership of these securities, and this
report should not be deemed an admission that the reporting person is the
beneficial owner of such securities for purposes of Section 16 or for any
other purpose.
**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.
/s/ Madie Ivy February 12, 1999
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**Signature of Reporting Person Date
Madie Ivy
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB number.
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SEC 2270 (9-96)
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