|
|
|
|
|
|
|
|
|
|
|
|
|
|
Previous: 1838 INVESTMENT ADVISORS FUNDS, N-30D, 2000-01-05 |
Next: PHOENIX GOLD INTERNATIONAL INC, DEF 14A, 2000-01-05 |
<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
- -------------------------------- --------------------------------
[ ] CHECK THIS BOX IF NO LONGER OMB Number: 3235-0287
SUBJECT TO SECTION 16. FORM 4 Expires: December 31, 2001
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)
1330 Avenue of the Americas
(Street)
New York New York 10019
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ESG Re Limited (ESREF)
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Statement of Month/Year
December 1999
5. If Amendment, Date or Original (Month/Year)
6. Relationship of Reporting Person to Issuer (Check all applicable)
X Director X 10% Owner
----- -----
X Officer (give title Other
----- below) ----- (specify
below)
Chief Executive Officer
----------------------------------------
7. Individual or Join/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
-----
Form filed by More than One Reporting Person
-----
<TABLE>
<CAPTION>
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 V Amount or Price (Instr. 3 (I) ship
(D) and 4) (Instr. 4) (Instr. 4)
- ----------------------------- -------------- ------------- ---------- --- ------- ----------------- ----------- ------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common shares, par value $1.00
per share 12/16/99 A 100 A $5.875(11) 8,785 (D)
Common shares, par value $1.00
per share 127,952 (I) As Trustee(1)
Common shares, par value $1.00
per share 3,000 (I) (2)
Common shares, par value $1.00
per share 9,098 (I) (2)
Common shares, par value $1.00
per share 9,098 (I) (2)
Common shares, par value $1.00
per share 455,457 (I) (3)
Common shares, par value $1.00
per share 10,695 (I) As Trustee(4)
Common shares, par value $1.00
per share 5,348 (I) As Trustee(5)
Common shares, par value $1.00
per share 465,241 (I) (6)
Common shares, par value $1.00
per share 812,505 (I) (7)
Common shares, par value $1.00
per share 20,000 (I) (8)
Common shares, par value $1.00
per share 80,000 (I) (9)
- ----------------------------- -------------- ------------- ---------- --- ------- ----------------- ----------- ------------
</TABLE>
Reminder: Report on a separate line for each class of (Over)
securities beneficially owned directly or indirectly. SEC 1474 (3-99)
* If the form is filed by more than one reporting person, see Instruction
4(b)(v).
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.
<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)
Security Year) ------------- ------------------------- ----------------------
Date Expira-
Code V (A) (D) Exer- tion
cisable Date
- -------------------------------------- ------------- ----------- ------------- ----------- ----------- ----------- ---------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
Class A Warrants $20/sh 12/22/97 12/22/07
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
Class A Warrants $20/sh 12/22/97 12/22/07
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
Class A Warrants $20/sh 12/22/97 12/22/07
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
Class A Warrants $20/sh 12/22/97 12/22/07
Class B Warrants $20/sh(10) 1/27/98 1/27/08
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
Class A Warrants $20/sh 12/22/97 12/22/07
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
- -------------------------------------- ------------- ----------- ------------- ----------- ----------- ----------- ---------
<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 shares 736 736 (D)
Common shares 63 63 (D)
Common shares 86 86 (D)
Common shares 588 588 (I) (2)
Common shares 51 51 (I) (2)
Common shares 69 69 (I) (2)
Common shares 588 588 (I) (2)
Common shares 51 51 (I) (2)
Common shares 69 69 (I) (2)
Common shares 107,451 107,451 (I) (3)
Common shares 871,427 871,427 (I) (3)
Common shares 105,097 105,097 (I) (3)
Common shares 276,240 276,240 (I) (3)
Common shares 1,176 1,176 (I) As Trustee (4)
Common shares 102 102 (I) As Trustee (4)
Common shares 137 137 (I) As Trustee (4)
Common shares 11,765 11,765 (I) As Trustee (1)
Common shares 1,017 1,017 (I) As Trustee (1)
- --------------------- --------------- ------------- ------------- ------------- --------------
</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)
Security Year) ------------- ------------------------- ----------------------
Date Expira-
Code V (A) (D) Exer- tion
cisable Date
- -------------------------------------- ------------- ----------- ------------- ----------- ----------- ----------- ---------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
Class A Warrants $20/sh 12/22/97 12/22/07
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
Class A Warrants $20/sh 12/22/97 12/22/07
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
Class A Warrants $20/sh 12/22/97 12/22/07
Class A Warrants $20/sh 12/3/97 12/3/07
Class A Warrants $20/sh 12/17/97 12/17/07
Class A Warrants $20/sh 12/22/97 12/22/07
Options to buy $20/sh 12/12/97 12/12/07
Options to buy $25.50/sh 5/4/98 5/04/08
Options to buy $20/sh 12/12/97 12/12/07
Options to buy $25.50/sh 5/04/98 5/04/08
Options to buy $16.81/sh 2/25/99 2/25/09
Options to buy $16.50/sh 5/7/99 5/7/09
- -------------------------------------- ------------- ----------- ------------- ----------- ----------- ----------- ---------
<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 shares 1,372 1,372 (I) As Trustee (1)
Common shares 588 588 (I) As Trustee (5)
Common shares 51 51 (I) As Trustee (5)
Common shares 69 69 (I) As Trustee (5)
Common shares 51,177 51,177 (I) (6)
Common shares 4,422 4,422 (I) (6)
Common shares 5,969 5,969 (I) (6)
Common shares 86,147 86,147 (I) (7)
Common shares 7,443 7,443 (I) (7)
Common shares 10,048 10,048 (I) (7)
Common shares 17,857 17,857 (I) (2)
Common shares 15,357 15,357 (I) (2)
Common shares 17,857 17,857 (I) (2)
Common shares 15,357 15,357 (I) (2)
Common shares 70,000 70,000 (I) (2)
Common shares 5,000 5,000 (I) (2)
- --------------------- --------------- ------------- ------------- ------------- --------------
</TABLE>
<PAGE>
FORM 4 (continued)
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
Explanation of Responses:
1. Held by Head Company Profit Sharing Plan.
2. Held by trust(s) for the benefit of heir(s) of John C Head III. The
reporting person disclaims beneficial ownership of these securities, and
this report shall not be deemed an admission that the reporting person is
the beneficial owner of such securities for any purpose.
3. Held by HMI Partners L.L.C., of which John C Head III is a General Partner
of the Managing Member.
4. Held by the Head Family Foundation.
5. Held by Head Company Pension Plan.
6. Held by Drake Holdings Limited, of which John C Head III is a Director.
7. Held by ESG Partners (Bermuda) L.P., of which John C Head III is a Managing
Member of the general partner.
8. Held by Charles Partners L.P., of which John C Head III is a Managing
Member of the General Partner.
9. Held by HIIB III L.L.C., of which John C Head III is a Managing Member of
the Managing Member.
10. Exercise Price of Class B Warrants decreases in future.
11. The Issuer issued 100 shares to John C Head III as compensation.
/s/ John C Head III January 5, 2000
------------------------------- -------------------
**Signature of Reporting Person Date
John C Head III
** 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.
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
|
|