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Previous: YANKEE ATOMIC ELECTRIC CO, 35-CERT, 2000-02-10 |
Next: ZENITH NATIONAL INSURANCE CORP, 4, 2000-02-10 |
<PAGE> 1
FORM 5
U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
[ ] CHECK THIS BOX IF NO LONGER
SUBJECT TO SECTION 16. FORM 4
OR FORM 5 OBLIGATIONS MAY
CONTINUE. SEE INSTRUCTION 1(b)
[ ] FORM 3 HOLDINGS REPORTED
[X] FORM 4 TRANSACTIONS REPORTED
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
(Print or Type Responses)
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
1. Name and Address of 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Persons to Issuer
Reporting Person* (Check all applicable)
FAIRFAX FINANCIAL ZENITH NATIONAL INSURANCE CORP. (ZNT) ___ Director _X_ 10% Owner
HOLDINGS LIMITED ___ Officer ___ Other
(give title below) (specify below)
(Last) (First) (Middle) 3. IRS or Social 4. Statement for ____________________________________
Security Number of Month/Year
Reporting Person
(Voluntary) December 31, 1999
95 Wellington Street West, Suite 800 5. If Amendment, 7. Individual or Joint/Group Filing (Check
Date of Original Applicable Line)
(Street) (Month/Year)
___ Form filed by One Reporting Person
Toronto, Ontario, Canada M5J 2N7 _X_ Form filed by More than One Reporting Person
(City) (State) (Zip)
TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
1. Title of Security 2. Trans- 3. Trans- 4. Securities 5. Amount of 6. Owner- 7. Nature of
(Instr. 3) action action Acquired (A) Securities ship Indirect
Date Code or Disposed of (D) Beneficially Form: Beneficial
(Instr. 3, 4 and 5) Owned at Direct Ownership
(Month/ End of Issuer's (D) or
Day/ Fiscal Year Indirect
Year) (Instr. 3 and (I)
(Instr. 4) (Instr. 4)
(A)
or
Code Amount (D) Price
Common Stock 12/7/99 P4 5,000 A $19.938 10,000 I Held by
12/8/99 P4 3,000 A $19.688 The North
12/9/99 P4 2,000 A $19.500 River
Insurance
Company
Common Stock 3,287,223 I Held by TIG
Insurance
Company
Common Stock 3,287,222 I Held by
United
States Fire
Insurance
Company
Common Stock 86,154 I Held by
Hamblin
Watsa
Investment
Counsel Ltd.
</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Page 1 of 3
<PAGE> 2
FORM 5 (CONTINUED) TABLE II--DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR
BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<TABLE>
<CAPTION>
1. Title of Derivative 2. Conversion or 3. Transaction 4. Transaction 5. Number of 6. Date Exer- 7. Title and Amount
Security (Instr. 3) Exercise Price Date (Month/ Code Derivative cisable and of Underlying
of Derivative Day/Year) (Instr. 8) Securities Expiration Securities
Security Acquired (A) Date (Month/ (Instr. 3 and 4)
or Disposed Day/Year)
of (D) (Instr.
3, 4 and 5)
(A) (D) Date Expira- Amount or
Exer- tion Number of
cisable Date Title Shares
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
</TABLE>
<TABLE>
<CAPTION>
8. Price of 9. Number of 10. Ownership Form 11. Nature of
Derivative Derivative of Derivative Indirect
Security Securities Security: Direct Beneficial
(Instr. 5) Beneficially (D) or Indirect Ownership
Owned at End (I) (Instr. 4) (Instr. 4)
of Year
(Instr. 4)
<C> <C> <C> <C>
</TABLE>
Explanation of Responses: FAIRFAX FINANCIAL HOLDINGS LIMITED
* Intentional misstatements or /s/ Eric P. Salsberg February 9, 2000
omissions of facts constitute -------------------------- ----------------
Federal Criminal Violations. * Name: Eric P. Salsberg Date
See 18 U.S.C. 1001 and 15 Title: Vice President
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.
<PAGE> 3
REPORTING PERSONS WHO ARE
BENEFICIAL OWNERS IN THE GROUP
(IN ADDITION TO THE DESIGNATED FILER,
FAIRFAX FINANCIAL HOLDINGS LIMITED)
<TABLE>
<CAPTION>
DATE OF EVENT
REPORTING PERSON ADDRESS ISSUER (SYMBOL) REQUIRING STATEMENT SIGNATURE OF REPORTING PERSON
- ---------------- ------- --------------- ------------------- -----------------------------
<S> <C> <C> <C> <C>
12/07/1999 BY: /s/ Dennis J. Hammer
THE NORTH RIVER 305 Madison Avenue ZENITH NATIONAL 12/08/1999 ------------------------
INSURANCE COMPANY P.O. Box 1943 INSURANCE CORP. ("ZNT") 12/09/1999 NAME: Dennis J. Hammer
Morristown, New Jersey TITLE: Vice President
07960 - 1943
TIG INSURANCE COMPANY 5205 North O'Connor Blvd. ZENITH NATIONAL 6/25/1999
Suite W-200 INSURANCE CORP. ("ZNT") BY: /s/ Courtney Smith
Irving, Texas ------------------------
75039 NAME: Courtney Smith
TITLE: President
UNITED STATES FIRE 305 Madison Avenue ZENITH NATIONAL 6/25/1999 BY: /s/ Denis J. Hammer
INSURANCE COMPANY P.O. Box 1943 INSURANCE CORP. ("ZNT") -------------------------
Morristown, New Jersey NAME: Denis J. Hammer
07960 - 1943 TITLE: Vice President
HAMBLIN WATSA 95 Wellington Street West ZENITH NATIONAL 6/25/1999 BY: /s/ V. Prem Watsa
INVESTMENT COUNSEL Suite 800 INSURANCE CORP. ("ZNT") -------------------------
LTD. Toronto, Ontario, Canada NAME: V. Prem Watsa
M5J 2N7 TITLE: Vice President
</TABLE>
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