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OMB APPROVAL
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OMB Number: 3235-0287
Expires: December 31, 2001
Estimated average burden
hours per response . . . 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
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 box if no longer subject of Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
(Print or Type Responses)
________________________________________________________________________________
1. Name and Address of Reporting Person*
Ivy Madie
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(Last) (First) (Middle)
1330 Avenue of the Americas
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(Street)
New York New York 10019
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(City) (State) (Zip)
________________________________________________________________________________
2. Issuer Name and Ticker or Trading Symbol
ESG Re Limited (ESREF)
________________________________________________________________________________
3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
________________________________________________________________________________
4. Statement for Month/Year
September 2000
________________________________________________________________________________
5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [X] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
________________________________________________________________________________
7. 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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<TABLE>
<CAPTION>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common shares,
par value $1.00 per share 8,636 (D)
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Common shares, As Trustee
par value $1.00 per share 9/22/00 P 15,000 (A) $3.0313 142,952 (I) (1)
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Common shares, As Trustee
par value $1.00 per share 21,196 (I) (2)
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Common shares,
par value $1.00 per share 464,897.991 (I) (3)
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Common shares, As Trustee
par value $1.00 per share 10,695 (I) (4)
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Common shares, As Trustee
par value $1.00 per share 5,348 (I) (5)
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Common shares,
par value $1.00 per share 9/04/00 J(11) 82,150 (D) $2-15/16 383,091 (I) (6)
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Common shares,
par value $1.00 per share 812,505 (I) (7)
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Common shares,
par value $1.00 per share 81,658.289 (I) (8)
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Common shares,
par value $1.00 per share 81,658.289 (I) (9)
====================================================================================================================================
</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
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.
(Over)
SEC 1474 (3-99)
<PAGE>
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
================================================================================
<TABLE>
<CAPTION>
10.
9. Owner-
Number ship
of Form
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- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (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> <C>
Class A Warrants $20/sh 12/3/97 12/3/07 Common
shares 735 735 (D)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common
shares 64 64 (D)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common
shares 86 86 (D)
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Class A Warrants $20/sh 12/3/97 12/3/07 Common As Trustee
shares 588 588 (I) (2)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common As Trustee
shares 51 51 (I) (2)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common As Trustee
shares 69 69 (I) (2)
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Class A Warrants $20/sh 12/3/97 12/3/07 Common As Trustee
shares 588 588 (I) (2)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common As Trustee
shares 51 51 (I) (2)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common As Trustee
shares 69 69 (I) (2)
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Class A Warrants $20/sh 12/3/97 12/3/07 Common
shares 107,451 107,451 (I) (3)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common
shares 871,427 871,427 (I) (3)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common
shares 105,097 105,097 (I) (3)
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Class B Warrants $20/sh(10) 1/27/98 1/27/08 Common
shares 276,240 276,240 (I) (3)
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Class A Warrants $20/sh 12/3/97 12/3/07 Common As Trustee
shares 1,176 1,176 (I) (4)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common As Trustee
shares 102 102 (I) (4)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common As Trustee
shares 137 137 (I) (4)
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Class A Warrants $20/sh 12/3/97 12/3/07 Common As Trustee
shares 11,765 11,765 (I) (1)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common As Trustee
shares 1,017 1,017 (I) (1)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common As Trustee
shares 1,372 1,372 (I) (1)
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Class A Warrants $20/sh 12/3/97 12/3/07 Common As Trustee
shares 588 588 (I) (5)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common As Trustee
shares 51 51 (I) (5)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common As Trustee
shares 69 69 (I) (5)
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Class A Warrants $20/sh 12/3/97 12/3/07 Common
shares 51,177 51,177 (I) (6)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common
shares 4,422 4,422 (I) (6)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common
shares 5,969 5,969 (I) (6)
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Class A Warrants $20/sh 12/3/97 12/3/07 Common
shares 86,147 86,147 (I) (7)
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Class A Warrants $20/sh 12/17/97 12/17/07 Common
shares 7,443 7,443 (I) (7)
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Class A Warrants $20/sh 12/22/97 12/22/07 Common
shares 10,048 10,048 (I) (7)
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Options to buy $20/sh 12/12/97 12/12/07 Common As Trustee
shares 17,857 17,857 (I) (2)
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Options to buy $25.50/sh 5/04/98 5/04/08 Common As Trustee
shares 15,357 15,357 (I) (2)
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Options to buy $20/sh 12/12/97 12/12/07 Common As Trustee
shares 17,857 17,857 (I) (2)
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Options to buy $25.50/sh 5/04/98 5/04/08 Common As Trustee
shares 15,357 15,357 (I) (2)
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Options to buy $16.81/sh 2/25/99 2/25/09 Common As Trustee
shares 70,000 70,000 (I) (2)
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Options to buy $16.50/sh 5/7/99 5/7/09 Common As Trustee
shares 5,000 5,000 (I) (2)
====================================================================================================================================
</TABLE>
Explanation of Responses:
1. Held by Head Company Profit Sharing Plan.
2. Held by trust(s) for the benefit of heir(s) of Madie Ivy. Madie Ivy is the
Managing Member of the trustee of the trust(s). The reporting person
disclaims beneficial ownership of these securities, and this report shall
not be deemed an admission that the reporting person is the beneficial
owner of such securities for any purpose.
3. Held by HMI Partners L.L.C., of which Madie Ivy is a Managing Member.
4. Held by the Head Family Foundation.
5. Held by Head Company Pension Plan.
6. Held by Drake Holdings Limited, of which Madie Ivy is Chairman and a
Director.
7. Held by ESG Partners (Bermuda) L.P., of which Madie Ivy is a Managing
Member of the General Partner.
8. Held by Charles Partners L.P., of which Madie Ivy is a Managing Member of
the General Partner.
9. Held by HII B III L.L.C. of which Madie Ivy is a Managing Member of the
Managing Member.
10 Exercise Price of Class B Warrants decreases in future.
11. In September 2000, 82,150 shares were deemed to belong to Drake Insurance
plc.
/s/ Madie Ivy October 10, 2000
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**Signature of Reporting Person Date
Madie Ivy
** 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.
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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