U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
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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1. Name and Address of Reporting Person*
Martin John E.
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(Last) (First) (Middle)
222 South 15th Street, Suite 600 North
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(Street)
Omaha NE 68102
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
12/14/99
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Acceptance Insurance Companies Inc. (AIF)
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
President and Chief Executive Officer
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6. If Amendment, Date of Original (Month/Day/Year)
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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
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Table I -- Non-Derivative Securities Beneficially Owned
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3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 4)
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<S> <C> <C> <C>
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* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Form 3-07/98)
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FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Non - qualified Stock
Options (Rights to Buy) * * Common Stock 200,000 * D
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*The options were granted December 14, 1999 and are subject to shareholder approval. The option to purchase 100,000 shares vests
on, and may be exercised any time after, December 1, 2000; the purchase price ("Initial Price") of those shares is the lower
of $5.50 per share or the average trading price per share during the first quarter of 2000. An option to purchase an additional
50,0000 shares vests on, and may be exercised any time after, December 1, 2001; the purchase price of those shares is One Dollar
($1.00) per share greater than the Initial Price. A second option to purchase an additional 50,000 shares vests on, and may be
exercised any time after, December 1, 2002; the purchase price of those shares is Two Dollars ($2.00) per share greater than the
Initial Price. All unexercised options expire December 14, 2009.
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Explanation of Responses:
/s/ John E. Martin December 28, 1999
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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.