UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
( ) Check box if no longer subject to Section 16.
Form 4 or Form 5 obligations may continue. See Instructions 1(b).
( ) Form 3 Holdings Reported
( ) Form 4 Transactions Reported
1. Name and Address of Reporting Person
Losi, II, Raymond H.
c/o Variflex, Inc.
5152 N. Commerce Avenue
Moorpark, CA 93021
USA
2. Issuer Name and Ticker or Trading Symbol
Variflex, Inc.
VFLX
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Statement for Month/Year
10/23/97
5. If Amendment, Date of Original (Month/Year)
6. Relationship of Reporting Person(s) to Issuer (Check all applicable)
( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other
(specify below)
President and Chief Operating Officer
7. Individual or Joint/Group Reporting (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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1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect |
|Transaction| or Disposed of (D) | Securities |ect | Beneficial Ownership |
|Date |Code| | Beneficially |(D)or | |
| | | | A/| | Owned at |Indir | |
| | | Amount | D | Price | End of Year |ect(I)| |
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Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned |
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1.Title of Derivative |2.Con |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of|
Security |version |Transaction rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect |
|or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial |
|cise Pr | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership |
|ice of | | | posed of(D) |Day/Year) | |rity |Benefi |or | |
|Deriva | | | |Date |Expir| | |ficially |Ind| |
|tive | | | | A/|Exer-|ation| Title and Number | |Owned at |ire| |
|Secu | | | | D |cisa-|Date | of Shares | |End of |ct | |
|rity | | | Amount | |ble | | | |Year |(I)| |
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Employee Stock Option (r|$5.50 |6/13/|A |90,000 |A |(1) |6/12/|Common Stock|90,000 | |90,000 |D | |
ight to buy) | |97 | | | | |02 | | | | | | |
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Employee Stock Option (r|$15.50 |6/13/|D |180,000 |D |(2) |4/1/9|Common Stock|180,000| |-0- |D | |
ight to buy) | |97 | | | | |9 | | | | | | |
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Explanation of Responses:
(1) The option shares become exercisable in five annual increments of 18,000
shares each, beginning on January 1, 1998.
(2) All option shares were exercisable as of January 1,
1997.
SIGNATURE OF REPORTING PERSON
/s/ William B. Ogden
DATE
October 23, 1997
