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Previous: SOUTHWEST SECURITIES GROUP INC, 10-Q, 1997-11-10 |
Next: ADVISORS INNER CIRCLE FUND, 497, 1997-11-10 |
<TABLE>
<CAPTION>
U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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
<S> <C>
- ----------------------------------- --------------------------------
FORM 4 OMB APPROVAL
- ----------------------------------- --------------------------------
[X] CHECK THIS BOX IF NO LONGER OMB Number: 3235-0287
SUBJECT TO SECTION 16. FORM 4 Expires: September 30, 1998
OR FORM 5 OBLIGATIONS MAY Estimated average burden
CONTINUE. SEE INSTRUCTION 1(B). hours per response .... 0.5
--------------------------------
</TABLE>
1. Name and Address of Reporting Person *
Head III John C
(Last) (First) (Middle)
c/o Head & Company LLC 1330 Avenue of the Americas
(Street)
New York New York 10019
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Integon Corporation
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Statement of Month/Year
October, 1997
5. If Amendment, Date or Original (Month/Year)
6. Relationship of Reporting Person to Issuer (Check all applicable)
Director 10% Owner
----- -----
Officer (give title X Other
----- below) ----- (specify
below)
Former Director
----------------------------------------
7. Individual or Join/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
-----
X Form filed by More than One Reporting Person
-----
<TABLE>
TABLE I-- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
1. Title of Security 2. Transaction 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
(Instr. 3) Date action or Disposed of (D) Securities ship of In-
Code (Instr. 3, 4 and 5) Beneficially Form: direct
(Month/ (Instr. 8) Owned at Direct Bene-
Day/ ------------- ------------------------- End of (D) ficial
Year) (A) Month Indirect Owner-
Code Amount or Price (Instr. 3 (I) ship
(D) and 4) (Instr. 4) (Instr. 4)
- ----------------------------- -------------- ------------- ---------- --- ------- --------------- ------------- -----------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock 10/17/97 U 462,345 D $26.00 O I Heracles
Partners
L.P.
Common Stock 10/17/97 U 10,494 D $26.00 O I Ivy Oil
Company
Limited
Common Stock 10/17/97 U 10,594 D $26.00 O I Head Oil
Company
Limited
Common Stock 10/17/97 U 12,300 D $26.00 O D
Common Stock 10/17/97 U 10,540 D $26.00 O I Spouse
Common Stock 10/17/97 U 6,935 D $26.00 O I PS Plan
FBO 01136
Common Stock 10/17/97 U 6,934 D $26.00 O I PS Plan
FBO 02294
Common Stock - Dividend
Reinvestment Program 10/17/97 U 68.22 D $26.00 O I Heracles
Partners
L.P.
Common Stock - Dividend
Reinvestment Program 10/17/97 U 99.94 D $26.00 O I Ivy Oil
Company
Limited
Common Stock - Dividend
Reinvestment Program 10/17/97 U 99.94 D $26.00 O I Head Oil
Company
Limited
Common Stock - Dividend
Reinvestment Program 10/17/97 U 95.45 D $26.00 O D
Common Stock - Dividend
Reinvestment Program 10/17/97 U 88.77 D $26.00 O I Spouse
Common Stock - Dividend
Reinvestment Program 10/17/97 U 12.94 D $26.00 O I PS Plan
FBO 01136
Common Stock - Dividend
Reinvestment Program 10/17/97 U 12.91 D $26.00 O I PS Plan
FBO 02294
Common Stock - Brokerage
Accounts 10/17/97 U 1100 D $26.00 O D
Common Stock - Brokerage
Accounts 10/17/97 U 1100 I $26.00 O I Spouse
Common Stock - Brokerage
Accounts 10/17/97 U 110 I $26.00 O I Child
Common Stock - Brokerage
Accounts 10/17/97 U 110 I $26.00 O I Child
- ----------------------------- -------------- ------------- ---------- --- ------- --------------- ------------- -----------
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 4(b)(v). SEC 1474 8-92)
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- 6. Date Exer-
Security (Instr. 3) sion or action tion Code ative Securities Ac- cisable and Ex-
Exercise Date (Instr. 8) quired (A) or Dis- piration Date
Price of posed of (D)
Deriv- (Month/ (Instr. 3, 4 and 5) (Month/Day/
ative Day/ Year)
Secur Year) ------------- ------------------------- ----------------------
Date Expira-
Code (A) (D) Exer- tion
cisable Date
- -------------------------------------- ------------- ----------- ------------- ----------- ----------- ----------- ---------
<S> <C> <C> <C> <C> <C> <C> <C>
$3.875 Convertible Preferred Stock $3.875 10/17/97 U 536 Immed. N/A
$3.875 Convertible Preferred Stock $3.875 10/17/97 U 536 Immed. N/A
$3.875 Convertible Preferred Stock $3.875 10/17/97 U 3,551 Immed. N/A
$3.875 Convertible Preferred Stock $3.875 10/17/97 U 3,452 Immed. N/A
$3.875 Convertible Preferred Stock $3.875 10/17/97 U 100 Immed. N/A
$3.875 Convertible Preferred Stock $3.875 10/17/97 U 100 Immed. N/A
- -------------------------------------- ------------- ----------- ------------- ----------- ----------- ----------- ---------
<CAPTION>
7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na-
Underlying Securities Deriv of Deriv- ship ture
ative ative Form of In-
(Instr. 3 and 4) Secur- Secur- of De- direct
ity ities rivative Bene-
(Instr. Bene Secu- ficial
5) ficially rity: Own-
Owned Direct ership
- -------------------------------------- at End (D) or (Instr. 4)
Amount or of Indi-
Title Number of Month rect (I)
Shares (Instr. 4) (Instr. 4)
- --------------------- --------------- ------------- ------------- ------------- --------------
<S> <C> <C> <C> <C> <C>
Common Stock 536 $68.24 0 I Ivy Oil Company Limited
Common Stock 536 $68.24 0 I Head Oil Company Limited
Common Stock 3,551 $68.24 0 D
Common Stock 3,452 $68.24 0 I Spouse
Common Stock 100 $68.24 0 I Child
Common Stock 100 $68.24 0 I Child
- --------------------- --------------- ------------- ------------- ------------- --------------
</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.
/s/ John C Head III 11/10/97
- ----------------------------------------------- ----------------------
**Signature of Reporting Person Date
John C Head III
<PAGE>
JOINT FILER INFORMATION
Name: Madie Ivy
Address: c/o Head & Company LLC
1330 Avenue of the Americas
New York, New York 10019
Designated Filer: John C Head III
Issuer: Integon Corporation
Date of Event: 10/17/97
Signature: /s/ Madie Ivy
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