4 1 form4ivyaug01.txt STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: December 31, 2001 Estimated average burden hours per response . . . 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 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 [_] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* Ivy Madie -------------------------------------------------------------------------------- (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 Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year August 2001 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 7. 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 Acquired, Disposed of, or Beneficially Owned ================================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8,636 (D) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, As Trustee par value $1.00 per share 142,952 (I) (1) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/28/01 M 100,000 (A) $2.1222 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/28/01 F 61,264 (D) $3.464 59,932 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 948,556 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, As Trustee par value $1.00 per share 10,695 (I) (4) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, As Trustee par value $1.00 per share 5,348 (I) (5) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 383,091 (I) (6) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/20/01 P 2,400 (A) 3.50 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/22/01 P 6,500 (A) 3.55 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/22/01 P 2,400 (A) 3.30 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/22/01 P 1,400 (A) 3.40 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/22/01 P 500 (A) 3.35 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/22/01 P 500 (A) 3.53 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/23/01 P 700 (A) 3.25 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/23/01 P 500 (A) 3.59 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/23/01 P 1,000 (A) 3.51 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/28/01 P 8,000 (A) 3.65 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/28/01 P 2,700 (A) 3.25 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/28/01 P 500 (A) 3.50 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/28/01 P 100 (A) 3.56 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/28/01 P 600 (A) 3.60 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/28/01 P 800 (A) 3.63 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/30/01 P 1,900 (A) 3.35 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8/31/01 P 400 (A) 3.35 1,037,863 (I) (7) ====================================================================================================================================
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 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 NUMBER. (Over) SEC 1474 (3-99) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common shares 735 735 (D) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common shares 64 64 (D) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common shares 86 86 (D) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common shares 1,176 1,176 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common shares 102 102 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common shares 138 138 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common shares 107,451 107,451 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common shares 871,427 871,427 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common shares 105,097 105,097 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Class B Warrants $20/sh(9) 1/27/98 1/27/08 Common shares 276,240 276,240 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common As Trustee shares 1,176 1,176 (I) (4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common As Trustee shares 102 102 (I) (4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common As Trustee shares 137 137 (I) (4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common As Trustee shares 11,765 11,765 (I) (1) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common As Trustee shares 1,017 1,017 (I) (1) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common As Trustee shares 1,372 1,372 (I) (1) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common As Trustee shares 588 588 (I) (5) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common As Trustee shares 51 51 (I) (5) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common As Trustee shares 69 69 (I) (5) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common shares 51,177 51,177 (I) (6) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common shares 4,422 4,422 (I) (6) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common shares 5,969 5,969 (I) (6) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common shares 86,147 86,147 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common shares 7,443 7,443 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common shares 10,048 10,048 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------ Options $20/sh 12/12/97 12/12/07 Common (right to buy) shares 35,714 35,714 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Options $25.50/sh 5/4/98 5/4/08 Common (right to buy) shares 30,714 30,714 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Options $16.81/sh 2/25/99 2/25/09 Common (right to buy) shares 70,000 70,000 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Options $16.50/sh 5/7/99 5/7/09 Common (right to buy) shares 5,000 5,000 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Options $5.4375/sh 12/15/99 12/15/09 Common (right to buy) shares 350,000 350,000 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Options $2.1222/sh 1/1/01 A 100,000 1/1/01 1/1/11 Common (right to buy) shares 100,000 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Options $2.1222/sh 1/1/01 M 100,000 1/1/01 1/1/11 Common (right to buy) shares 100,000 -0- (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Options $3.464 8/28/01 A V 61,264 8/28/01 1/1/11 Common (right to buy) shares 61,264 61,264 (I) (2) ====================================================================================================================================
Explanation of Responses: 1. Held by Head Company Profit Sharing Plan. 2. Held by trust(s) for the benefit of heir(s) of Madie Ivy. Madie Ivy is the Managing Member of the trustee of the trust(s). 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 two limited liability companies, of which Madie Ivy is a Managing Member and a Managing Member of the Managing Member, respectively. 4. Held by the Head Family Foundation. 5. Held by Head Company Pension Plan. 6. Held by a limited partnership, of which Madie Ivy is the Co-Chief Executive Officer of the General Partner. 7. Held by two limited partnerships, of which Madie Ivy is a Managing Member of the General Partner. 8. Exercise Price of Class B Warrants decreases in future. /s/ Madie Ivy September 5, 2001 --------------------------------------------- ----------------------- **Signature of Reporting Person Date Madie Ivy ** 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