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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).
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1. Name and Address of Reporting Person*
Jacobsen Raymond W.
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(Last) (First) (Middle)
c/0 EBI Companies
500 Park Blvd., Suite 900
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(Street)
Itasca, IL 60143
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(City) (State) (Zip)
Orion Capital Corporation (OC)
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2. Issuer Name and Ticker or Trading Symbol
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
December 1998
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
Executive Vice President
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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 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 Stock, $1.00 par value 12/23/98 M 7236 A $11.96 17,920 D
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Common Stock, $1.00 par value (1) V 464 A (1) 4,746 I ESOP Trust
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Common Stock, $1.00 par value J(2) 8,000 D
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</TABLE>
(Over)
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).
(Form 4-07/98)
<PAGE>
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities)
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<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>
Stock Option $11.96 12/21/98 M 7236 9/9/96 9/9/02 Common 7236 3448 D
(Right to Purchase) Stock
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Phanton Stock (3) (3) Common 1780(3) D
Equivalents(3) Stock
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Stock Option $16.20 6/2/94 6/2/03 Common 3126(4) D
(Right to Buy) (4) (4) Stock
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Stock Option $16.375 9/12/95 9/12/04 Common 16000 D
(Right to Buy) (4) (4) Stock (4)
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Stock Option $25.50 9/10/97 9/10/06 Common 15436 D
(Right to Buy) (4) (4) Stock (4)
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Stock Option $43.5625 9/12/98 9/12/07 Common 8032 D
(Right to Buy) (4) (4) Stock (4)
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</TABLE>
Explanation of Responses:
(1) These shares were acquired during the fiscal year under the Orion Capital
Corporation Employees' Stock Savings and Retirement Plan at prices ranging
from $33.00 to $57.875 per share in transactions that were exempt from
Section 16(a) by virtue of old Rule 16a-8(b). The information presented is
as of December 31, 1998.
(2) Non-vested restricted stock held as of 12/31/97 pursuant to the Orion
Capital Corporation 1982 Long-Term Performance Incentive Plan granted in
transactions exempt under old Rule 16b-3.
(3) Reports previously reported grants to reporting person of phantom stock
equivalents under the Orion Capital Corporation Deferred Compensation Plan
in transactions exempt under old rule 16b-3 and were calculated at prices
ranging from $31.50 to $46.4375 and include reinvestment of dividends.
These phantom stock equivalents may be paid in shares of Orion Common Stock
after date of termination. The information provided is as of 12/31/97.
(4) Reports previously reported grants to reporting person of option to buy
shares of Common Stock under the Orion Capital Corporation 1982 Long-Term
Performance Incentive Plan in a transaction exempt under Rule 16b-3. Each
option becomes exercisable in 25% annual increments beginning on the first
anniversary date of grant.
** 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.
/s/ John J. McCann January 8, 1999
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**Signature of Reporting Person Date
Raymond W. Jacobsen by John J. McCann
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 current
valid OMB Number.
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