-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, BHqplx2Z725Fmjd29Rbnod+j4jW+lQeECHI9tBmZ/GiXi7G4WDK6g6DQ5+VSnjqR D5vudHpCyjI868vlEvI62Q== 0001209191-07-045947.txt : 20070806 0001209191-07-045947.hdr.sgml : 20070806 20070806062622 ACCESSION NUMBER: 0001209191-07-045947 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20070727 FILED AS OF DATE: 20070806 DATE AS OF CHANGE: 20070806 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: UNITED STATES FIRE INSURANCE CO CENTRAL INDEX KEY: 0000101618 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025579 BUSINESS ADDRESS: STREET 1: 305 MADISON AVENUE STREET 2: PO BOX 1943 CITY: MORRISTOWN STATE: NJ ZIP: 07962 BUSINESS PHONE: 9734906600 MAIL ADDRESS: STREET 1: 305 MADISON AVENUE STREET 2: PO BOX 1943 CITY: MORRISTOWN STATE: NJ ZIP: 07962 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NORTH RIVER INSURANCE CO CENTRAL INDEX KEY: 0001276001 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025580 BUSINESS ADDRESS: STREET 1: 305 MADISON AVENUE STREET 2: PO BOX 1943 CITY: MORRISTOWN STATE: NJ ZIP: 07962 BUSINESS PHONE: 9734906600 MAIL ADDRESS: STREET 1: 305 MADISON AVENUE STREET 2: PO BOX 1943 CITY: MORRISTOWN STATE: NJ ZIP: 07962 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ODYSSEY AMERICA REINSURANCE CORP CENTRAL INDEX KEY: 0001243947 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025581 MAIL ADDRESS: STREET 1: 300 FIRST STAMFORD PLACE CITY: STAMFORD STATE: CT ZIP: 06902 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TIG INSURANCE CO CENTRAL INDEX KEY: 0001276413 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025583 BUSINESS ADDRESS: STREET 1: 5205 NORTH OCONNOR BLVD CITY: IRVING STATE: TX ZIP: 75039 BUSINESS PHONE: 972 831 5000 MAIL ADDRESS: STREET 1: 65 EAST 55TH STREET STREET 2: 28TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SIXTY TWO INVESTMENT CO LTD CENTRAL INDEX KEY: 0001217251 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025585 BUSINESS ADDRESS: STREET 1: 1600 CATHEDRAL PLACE STREET 2: 925 WEST GEORGIA ST CITY: VANCOUVER BC CANADA STATE: A1 ZIP: V6C3L3 MAIL ADDRESS: STREET 1: 1600 CATHEDRAL PLACE STREET 2: 925 W GEORGIA ST CITY: VANCOUVER BC CANADA STATE: A1 ZIP: V6C3L3 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: 1109519 ONTARIO LTD CENTRAL INDEX KEY: 0001275993 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025586 BUSINESS ADDRESS: STREET 1: FAIRFAX FINANCIAL HOLDINGS STREET 2: 95 WELLINGTON ST W STE 800 CITY: TORONTO ONTARIO CANADA STATE: A6 ZIP: 00000 BUSINESS PHONE: 4163669544 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WATSA V PREM ET AL CENTRAL INDEX KEY: 0000938869 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025587 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FAIRFAX FINANCIAL HOLDINGS LTD/ CAN CENTRAL INDEX KEY: 0000915191 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] STATE OF INCORPORATION: A6 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025588 BUSINESS ADDRESS: STREET 1: 95 WELLINGTON ST WEST STREET 2: STE 800 CITY: TORONTO ONTARIO CANA STATE: A6 BUSINESS PHONE: 4163674941 MAIL ADDRESS: STREET 1: FAIRFAX FINANCIAL HOLDINGS LTD STREET 2: 95 WELLINGTON ST WEST STE 800 CITY: TORONTO ONTARIO CANA STATE: A6 FORMER NAME: FORMER CONFORMED NAME: FAIRFAX FINANCIAL HOLDINGS LTD DATE OF NAME CHANGE: 19931122 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: International Coal Group, Inc. CENTRAL INDEX KEY: 0001320934 STANDARD INDUSTRIAL CLASSIFICATION: BITUMINOUS COAL & LIGNITE SURFACE MINING [1221] IRS NUMBER: 202641185 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 300 CORPORATE CENTRE DRIVE CITY: SCOTT DEPOT STATE: WV ZIP: 25560 BUSINESS PHONE: 304-760-2400 MAIL ADDRESS: STREET 1: 300 CORPORATE CENTRE DRIVE CITY: SCOTT DEPOT STATE: WV ZIP: 25560 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: 810679 ONTARIO LTD CENTRAL INDEX KEY: 0001275986 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025584 BUSINESS ADDRESS: STREET 1: 95 WELLINGTON STREET WEST SUITE 800 CITY: TORONTO ONTARIO CANADA STATE: A6 ZIP: 00000 BUSINESS PHONE: 4163674941 MAIL ADDRESS: STREET 1: 95 WELLINGTON STREET WEST SUITE 800 CITY: TORONTO ONTARIO CANADA STATE: A6 ZIP: 00000 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ODYSSEY RE HOLDINGS CORP CENTRAL INDEX KEY: 0001137048 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32679 FILM NUMBER: 071025582 BUSINESS ADDRESS: STREET 1: 300 FIRST STAMFORD PL CITY: STAMFORD STATE: CT ZIP: 06902 BUSINESS PHONE: 2039778000 MAIL ADDRESS: STREET 1: 300 FIRST STAMFORD PL CITY: STAMFORD STATE: CT ZIP: 06902 3 1 bay37258_bay2ffhl2.xml MAIN DOCUMENT DESCRIPTION X0202 3 2007-07-27 0 0001320934 International Coal Group, Inc. ICO 0000915191 FAIRFAX FINANCIAL HOLDINGS LTD/ CAN 95 WELLINGTON STREET WEST, SUITE 800 TORONTO, ON M5J2N7 0 0 1 0 0000938869 WATSA V PREM ET AL 95 WELLINGTON STREET WEST, SUITE 800 TORONTO, ON M5J2N7 0 0 1 0 0001275993 1109519 ONTARIO LTD 95 WELLINGTON STREET WEST, SUITE 800 TORONTO, ON M5J2N7 0 0 1 0 0001217251 SIXTY TWO INVESTMENT CO LTD 1600 CATHEDRAL PLACE 925 WEST GEORGIA ST. VANCOUVER, BC V6C3L3 0 0 1 0 0001275986 810679 ONTARIO LTD 95 WELLINGTON STREET WEST, SUITE 800 TORONTO, ON M5J2N7 0 0 1 0 0001276413 TIG INSURANCE CO 5205 NORTH O'CONNOR BLVD. IRVING, TX 75039 0 0 1 0 0001137048 ODYSSEY RE HOLDINGS CORP 300 FIRST STAMFORD PLACE STAMFORD, CT 06902 0 0 1 0 0001243947 ODYSSEY AMERICA REINSURANCE CORP 300 FIRST STAMFORD PLACE STAMFORD, CT 06902 0 0 1 0 0000101618 UNITED STATES FIRE INSURANCE CO 305 MADISON AVENUE MORRISTOWN, NJ 07962 0 0 1 0 0001276001 NORTH RIVER INSURANCE CO 305 MADISON AVENUE MORRISTOWN, NJ 07962 0 0 1 0 Common Stock, $0.01 Par Value ("Shares") 1200000 D Common Stock, $0.01 Par Value 16299500 I See Footnote 9.00% Convertible Senior Notes due 2012 (the "Senior Notes") 2012-02-01 Common Stock, $0.01 par value 2457204 D 9.00% Convertible Senior Notes due 2012 2012-02-01 Common Stock, $0.01 par value 2457204 I See Footnote 8,343,363 Shares are held by Odyssey America Reinsurance Corporation, 1,435,900 Shares are held by United States Fire Insurance Company, 4,682,237 Shares are held by The North River Insurance Company and 1,838,000 Shares are held by TIG Insurance Company. The Senior Notes may become convertible earlier than 02/01/12 upon the occurrence of certain trigger events, as set forth in the indenture (the "Indenture") governing the Senior Notes. The Senior Notes will be convertible until the close of business on the business day immediately preceding 08/01/12. The Senior Notes are convertible into cash and, if applicable, Shares based on an initial conversion rate, subject to adjustment, of 163.8136 Shares per $1,000 principal amount of Senior Notes. Upon conversion, in lieu of Shares, for each $1,000 principal amount of Senior Notes a holder will receive an amount in cash equal to the lesser of (i) $1,000 and (ii) the conversion value, determined in the manner set forth in the Indenture governing the Senior Notes. If the conversion value exceeds $1,000, ICO will also deliver, at its election, cash or Shares or a combination of cash and Shares for the conversion value in excess of $1,000. $7.5 million of Senior Notes are held by Odyssey America Reinsurance Corporation and $7.5 million of Senior Notes are held by TIG Insurance Company. /s/ Paul Rivett 2007-08-03 /s/ V. Prem Watsa 2007-08-03 /s/ V. Prem Watsa 2007-08-03 /s/ V. Prem Watsa 2007-08-03 /s/ V. Prem Watsa 2007-08-03 /s/ William J. Gillett 2007-08-03 /s/ Donald L. Smith 2007-08-03 /s/ Donald L. Smith 2007-08-03 /s/ Felicia Garland 2007-08-03 /s/ Felicia Garland 2007-08-03 -----END PRIVACY-ENHANCED MESSAGE-----