<PAGE>
<TABLE>
<CAPTION>
- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION -----------------------------
FORM 5 WASHINGTON, D.C. 20549 OMB APPROVAL
- -------- -----------------------------
/ / CHECK BOX IF NO LONGER ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0362
SUBJECT TO SECTION 16. EXPIRES: SEPTEMBER 30, 1998
FORM 4 OR FORM 5 OBLI- Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN
GATIONS MAY CONTINUE. Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 1.0
SEE INSTRUCTION 1(b). Section 30(f) of the Investment Company Act of 1940 -----------------------------
/ / FORM 3 HOLDINGS REPORTED
/ / FORM 4 TRANSACTIONS REPORTED
- ------------------------------------------------------------------------------------------------------------------------------------
<S><C>
1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s)
to Issuer (Check all applicable)
X Director 10% Owner
GENTZ WILLIAM L. SUPERIOR NATIONAL INSURANCE GROUP, INC. (SNTL) ---- ----
- ------------------------------------------------------------------------------------------- X Officer (give Other (specify
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- title ---- below)
Number of Reporting Month/Year below)
C/O SUPERIOR NATIONAL INSURANCE GROUP, INC. Person (Voluntary) CHAIRMAN OF THE BOARD
26541 AGOURA ROAD 02/00 --------------------------
- ------------------------------------------- -------------------------------------------------------------
(Street) 5. If Amendment, 7. Individual or Joint/Group Reporting
Date of Original (check applicable line)
(Month/Year) X Form Filed by One Reporting Person
---
Form filed by More than One
Reporting Person
CALABASAS CA 91302 ---
- ------------------------------------------------------------------------------------------------------------------------------------
(City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
- ------------------------------------------------------------------------------------------------------------------------------------
1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) or 5. Amount of 6. Owner- 7. Nature of
(Instr. 3) action tion Disposed of (D) Securities ship Indirect
Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial
(Instr. 8) Owned at Direct Ownership
(Month/ end of (D) or (Instr. 4)
Day/ ------------------------------ Issuer's Indirect
Year) Amount (A) or Price Fiscal Year (I)
(D) (Instr. 3 (Instr. 4)
and 4)
- ------------------------------------------------------------------------------------------------------------------------------------
COMMON STOCK 2/16/99 A(1) 7,406 A $19.375 75,340(2) D
- ------------------------------------------------------------------------------------------------------------------------------------
COMMON STOCK 120,000 I BY TRUST
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
*If the form is filed by more than one reporting person, see instruction 4(b)(v). (Over)
SEC 2270 (7/97)
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 CONTROL NUMBER.
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
FORM 5 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
- ------------------------------------------------------------------------------------------------------------------------
1. Title of Derivative Security 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer-
(Instr. 3) sion of action action Derivative cisable and
Exercise Date Code Securities Ac- Expiration
Price of (Month/ (Instr. 8) quired (A) or Date
Deriv- Day/ Disposed of Month/Day/
ative Year) (D) Year)
Security (Instr. 3, 4, and 5)
--------------------
Date Expir-
---------------------- Exer- ation
cisable Date
(A) (D)
<S><C>
- ------------------------------------------------------------------------------------------------------------------------
EMPLOYEE STOCK OPTION $19.375 2/16/99 A 14,813 (3) 2/15/09
- ------------------------------------------------------------------------------------------------------------------------
CALL OPTION (RIGHT TO BUY) $20.00(1) 11/22/99 D 120,000 11/22/99 NONE
- ------------------------------------------------------------------------------------------------------------------------
PUT OPTION (RIGHT TO SELL) $10.00(1) 11/22/99 D 232,390(5) 11/30/02 NONE
- ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------
<CAPTION>
- ------------------------------------------------------------------------------------------
7. Title and Amount of Under- 8. Price 9. Number 10. Owner- 11. Na-
lying Securities of of Deriv- ship ture of
(Instr. 3 and 4) Deriv- ative of Indirect
ative Secur- Deriv- Bene-
Secur- ities ative ficial
ity Bene- Secur- Owner-
(Instr. ficially ity: ship
5) Owned Direct (Instr. 4)
- ------------------------------------ at End (D)
of Year or In-
Amount or (Instr. 4) direct
Title Number of (I)
Shares (Instr. 4)
<S><C>
- ------------------------------------------------------------------------------------------
COMMON STOCK 14,813 14,813 D
- ------------------------------------------------------------------------------------------
COMMON STOCK 120,000 (4) 120,000 I BY TRUST
- ------------------------------------------------------------------------------------------
COMMON STOCK 112,390(5) (4) 112,390(5) D
- ------------------------------------------------------------------------------------------
120,000(5) I BY TRUST
- ------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------
Explanation of Responses:
(1) The reported security represents a grant of restricted stock pursuant to the Company's
1995 Stock Incentive Plan.
(2) Includes shares of restricted stock subject to the Company's right to repurchase as of
the date hereof.
(3) The reported security represents stock options granted pursuant to the Company's 1995
Stock Incentive Plan that vest in equal annual increments of 20% over a five-year period
following their date of grant, February 16, 1999.
(4) On November 22, 1999, Mr. Gentz and a revocable trust of which he is trustee
entered into an Amendment Agreement (the "Amendment") with Superior National Insurance
Group, Inc. (the "Company") whereby the parties amended the terms of a promissory note
and a pledge agreement pursuant to which Mr. Gentz purchased 120,000 shares of Company
Common Stock on November 20, 1998 at $16.75 per share. The Board of Directors approved
the Amendment Agreement on November 16, 1999. Pursuant to the Amendment, Mr. Gentz and
the Company have agreed, contingent upon Mr. Gentz's continuing in employment for
three (3) years, or upon the occurrence of certain other events, to treat the collateral
pledged under the pledge agreement as having a minimum value of $10.00 per common
share. Thus, if there is a foreclosure on the pledge, the maximum loss per share of
stock purchased with the note in November 1998 would be $6.75, plus accrued and unpaid
interest on the note. This agreement is treated as a "put option" under Section 16 of
the Securities Exchange Act, although nothing under the terms of the Amendment could
be construed as giving Mr. Gentz the right to cause the Company to purchase his
collateral. In addition, Mr. Gentz has agreed (i) to a maximum gain of $3.25 per share
on the sale of the 120,000 shares of Common Stock (treated as a "Call Option" for
reporting purposes, although the Company has no right to compel Mr. Gentz to sell his
shares to the Company), with any additional gain for the benefit of the Company, (ii)
to provide the Company with additional collateral on the note in the form of offset
rights against any severance benefits Mr. Gentz might obtain, and (iii) to consent to
a 5% reduction in his base salary.
(5) Includes in total (i) 120,000 shares of Common Stock which Mr. Gentz, through a
revocable trust, purchased with the note in November 1998, (ii) 75,340 shares of Common
Stock owned by Mr. Gentz directly and pledged as additional collateral, and (iii)
options to purchase 37,050 shares of Common Stock, all pledged as collateral for the
note.
/s/ WILLIAM L. GENTZ 02/11/00
----------------------------------- -----------
**Intentional misstatements or omissions of facts constitute **Signature of Reporting Person Date
Federal Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). WILLIAM L. GENTZ
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. Page 2
SEC 2270 (7-97)
</TABLE>
