SEC Form 3
FORM 3 UNITED STATES 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
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Klobnak Jennifer L

(Last) (First) (Middle)
9025 N. LINDBERGH DRIVE

(Street)
PEORIA IL 61615

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/04/2016
3. Issuer Name and Ticker or Trading Symbol
RLI CORP [ RLI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
Sr. VP, Operations - RLI Ins.
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 6,002 D
Common Stock 13,449.6063 I RLI Corp. Employee Stock Ownership Plan(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option 05/05/2012(2) 05/05/2019 Common Stock 280 $17.865(3) D
Stock Option 05/03/2013(2) 05/03/2020 Common Stock 560 $25.35(3) D
Stock Option 09/03/2013(2) 09/03/2020 Common Stock 4,000 $23.195(3) D
Stock Option 05/02/2014(2) 05/02/2021 Common Stock 12,000 $29.42(3) D
Stock Option 05/01/2015(2) 05/01/2022 Common Stock 15,000 $38.21(3) D
Stock Option 05/07/2016(2) 05/07/2023 Common Stock 15,000 $47.61(3) D
Explanation of Responses:
1. Balance reflects annual company contributions and dividend reinvestment.
2. Pursuant to option schedule wherein 20% of the aggregate number of shares granted may be exercised commencing one year from grant date and each year thereafter in 20% increments.
3. Exercise price reflects prior adjustments as a result of special dividends.
/s/ Jennifer L. Klobnak 02/09/2016
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** 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 is insufficient, see Instruction 6 for procedure.
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