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OMB APPROVAL
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- -------- OMB Number: 3235-0104
FORM 3 Expires: December 31, 2001
- -------- Estimated average burden
hours per response.... 0.5
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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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<S> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
Statement Trading Symbol of Original
Gibbs, Robert J. (Month/Day/Year) MSI Holdings, Inc. (MSIA) (Month/Day/Year)
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(Last) (First) (Middle) 6/25/99 5. Relationship of Reporting -----------------------
501 Waller ---------------------------- Person(s) to Issuer 7. Individual or Joint/
- ---------------------------------------- 3. I.R.S. Identification (Check all applicable) Group Filing (Check
(Street) Number of Reporting Director 10% Owner Applicable Line)
Person, if an entity ----- ----- X Form filed by
Austin, Texas 78702 (voluntary) X Officer Other (specify --- One Reporting
- -------------------------------------- ----- ----- below) Person
(City) (State) (Zip) ---------------------------- (give title below) Form filed by
President and Chief Executive Officer --- More than One
-------------------------------------- Reporting Person
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TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 5)
(Instr. 5)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
*If the form is filed by more than one reporting person, see Instruction 5(b)(v). SEC 1473 (3-99)
POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTIONS OF INFORMATION
CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS
A CURRENTLY VALID OMB CONTROL NUMBER.
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C>
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deri- ative
vative Security:
Security Direct
------------------------------------------------- (D) or
Date Expira- Amount or Indirect (I)
Exercis- tion Title Number (Instr. 5)
able Date of Shares
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Option 6/25/99 (1) Common Stock 272,590 $5.5625 D
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Explanation of Responses:
(1) The option expires the earlier of (a) the day of termination of continuing employment or consulting relationship with the
Company and its Subsidiaries for cause, as defined in any then existing written employment agreement between the Company or any
Subsidiary and Mr. Gibbs or (in the absence of such an agreement) as determined by a committee of the Board of Directors, (b) the
30th day after termination of continuing employment or consulting relationship with the Company and its Subsidiaries for any reason
other than death, permanent disability, cause or retirement at or after seventy (70) years of age; (c) one (1) year after the death
or permanent disability of Mr. Gibbs or the retirement of Mr. Gibbs at or after age 70; or (d) June 25, 2004.
/s/ Robert J. Gibbs 7/27/99
**Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- -------------
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date
Note. File three copies of this Form, one of which must be manually signed. Page 2
If space is insufficient, See Instruction 6 for procedure. SEC 1473 (3-99)
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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.
