<TABLE>
<CAPTION>
U.S. 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
<S> <C>
--------------------------------
OMB APPROVAL
- ----------------------------------- --------------------------------
FORM 3 OMB Number: 3235-0104
- ----------------------------------- Expires: September 30, 1998
Estimated average burden
hours per response .... 0.5
--------------------------------
</TABLE>
1. Name and Address of Reporting Person *
IP/MCLP General Partnership IV
(Last) (First) (Middle)
201 Main Street Suite 3100
(Street)
Fort Worth Texas 76102
(City) (State) (Zip)
2. Date of Event Requiring Statement ( Month / Day / Year )
January 16, 1998
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Issuer Name and Ticker or Trading Symbol
Superior National Insurance Group, Inc. (SNTL)
5. Relationship of Reporting Person to Issuer (Check all applicable)
Director X 10% Owner
----- -----
Officer (give title Other
----- below) ----- (specify
below)
----------------------------------------
6. If Amendment, Date or Original (Month/Year)
7. Individual or Join/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
-----
Form filed by More than One Reporting Person
-----
<TABLE>
<CAPTION>
TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
1. Title of security 2. Amount of Securities 3. Ownership 4. Nature of Indirect
(Inst.4) Beneficially Owned Form: Direct (D) Beneficial Ownership
(Instr. 4) or Indirect (I) (Instr. 5)
(Inst. 5)
- ---------------------------------------------- ------------------------------ ------------------- -------------------------------
<S> <C> <C> <C>
Common Stock 16,017 D
- ---------------------------------------------- ------------------------------ ------------------- -------------------------------
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(8-92)
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS,
CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative Security 2. Date Exercisable and 3. Title and Amount of Securities Underlying
(Instr. 4) Expiration Date Derivative Security (Instr. 4)
(Month/Day/Year)
Amount or
Date Expiration Title Number of
Exercisable Date Shares
- --------------------------------------------------- ----------- ----------- ---------------------- -----------------------------
<S> <C> <C> <C> <C>
- --------------------------------------------------- ----------- ----------- ---------------------- -----------------------------
<CAPTION>
4. Conversion or 5. Ownership 6. Nature of Indirect
Exercise Price of Form of Beneficial Ownership
Derivative Derivative (Instr. 5)
Security Security:
Direct (D) or
Indirect (I)
(Instr. 5)
- ---------------------------- --------------------- ------------------------------------------------
<S> <C> <C>
- ---------------------------- --------------------- ------------------------------------------------
</TABLE>
Explanation of Responses:
**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.
IP/MCLP General Partnership IV
By: Insurance Partners, L.P., Managing General Partner
By: Insurance GenPar, L.P., General Partner
By: Insurance GenPar MGP, L.P., General Partner
By: Insurance GenPar MGP, Inc., General Partner
/s/ Daniel L. Doctoroff January 29, 1998
- ----------------------------------------------- ----------------------
**Signature of Reporting Person Date
Daniel L. Doctoroff, Vice President
