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FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
[ ] Check this box if no WASHINGTON, D.C. 20549 OMB Number 3235-0362
longer subject to Section 16. Expires: October 31, 2001
Form 4 or Form 5 obligations may Estimated average burden
continue. See Instruction 1(b). hours per response...1.0
[ ] Form 3 Holdings Reported.
[X] Form 4 Holdings Reported.
AMENDED ANNUAL 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
1. Name and Address of Reporting Person*
------------------------------------
Valassis Doug T.
(Last) (First) (Middle)
520 Lake Cook Road, Suite 380
(Street)
Deerfield Illinois 60015
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol: Acceptance Insurance Companies, Inc. (AIF)
3. IRS or Social Security Number of Reporting Person (Voluntary): n/a
4. Statement for Month/Year: December 1999
5. If Amendment, Date of Original (Month/Year): February 2000
6. Relationship of Reporting Person to Issuer
(Check all applicable):
[X] 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 files by More than One Reporting Person
Table I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
6.
4. 5. Owner-
Securities Acquired (A) Amount of ship
3. or 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 Issuer's Indirect Beneficial
Title of Security Date ------------ or Fiscal Year (I) Ownership
(Instr.3) (mm/dd/yy) Code V Amount (D) Price (Instr.3,4) (Instr.4) (Instr.4)
- ----------------- ----------- ------------ ----------------------- ------------ --------- ----------
Common Stock 01/01/2000 J 8,000 shs. A <1> 8,000 shs. Indirect Owned by
Valassis
Enterprises,L.P.
1,680,345 shs. Indirect Owned by
VELP 2, LLC
142,879 shs. Direct n/a
2,065 shs. Indirect owned by
Franklin Enter-
prises, Inc.
7,500 shs. Direct<2> n/a
<1> Shares acquired upon withdrawal from an investment partnership in which Valassis Enterprises, L.P. was a
partner.
<2> Shares that may be acquired upon exercise of presently exercisable stock options.
*If form is filed by more than one reporting person, see instruction 4(b)(v).
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Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3): Option to Purchase
2. Conversion or Exercise Price of Derivative Security: $15.44
3. Transaction Date (mm/dd/yy): 05/27/1999
4. Transaction Code (Instr. 8)-- A
5. Number of Derivative Securities Acquired (A) or Disposed of (D)(Instr. 3, 4 and 5)--
(A): 1,500
(D): 0
6. Date Exercisable and Expiration Date--
Date Exercisable: 05/26/2000
Expiration Date: 05/26/2009
7. Title and Amount of Underlying Securities (Instr. 3 and 4)--
Title: Common Stock
Amount or Number of Shares: 1,500
8. Price of Derivative Security (Instr. 5): None
9. Number of Derivative Securities Beneficially Owned at End of Month (Instr. 4): 1,500
10. Ownership of Derivative Security: Direct (D) or Indirect (I)(Instr. 4): D
11. Nature of Indirect Beneficial Ownership (Instr. 4): n/a
Explanation of Responses:
/S/ DOUG T. VALASSIS
**Signature of Reporting Person Date: March 17, 2000
**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.
SEC 2270(3-99)
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