4 1 form4ivysep02.txt ESG RE LIMITED/MADIE IVEY ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: January 31, 2005 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 this box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ================================================================================ 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 or Social Security Number of Reporting Person (Voluntary) ================================================================================ 4. Statement for Month/Day/Year 09/18/02 ================================================================================ 5. If Amendment, Date of Original (Month/Day/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) Chairman of the Board ================================================================================ 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. 2. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of Transaction Code ------------------------------- Owned at End (D) or Indirect 1. Date (Instr. 8) (A) of Month Indirect Beneficial Title of Security (Month/ ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) Day/Year) Code V (D) and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 8,636 (D) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, As par value $1.00 per share 196,852 (I) Trustee(1) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 72,114 (I) (2) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 9/18/2002 P 10,100 (A) $0.94 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 9/18/2002 P 24,100 (A) $0.95 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 9/18/2002 P 500 (A) $0.93 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 9/18/2002 P 100,000 (A) $0.92 1,165,312 (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, As par value $1.00 per share 9/18/2002 P 10,000 (A) $0.90 39,695 (I) Trustee(4) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, As par value $1.00 per share 5,348 (I) Trustee(5) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 383,091 (I) (6) ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value $1.00 per share 1,133,088 (I) (7) ------------------------------------------------------------------------------------------------------------------------------------
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. 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 (9-02) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
9. Number 10. of Owner- Deriv- ship ative Form 2. Secur- of Conver- 5. 7. ities Deriv- 11. sion 3A Number of Title and Amount Bene- ative Nature of Deemed Derivative 6. of Underlying 8. ficially Secur- of Exer- Exe- 4. Securities Date Securities Price Owned ity: In- cise 3. cution Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Follow- Direct direct Price Trans- Date, action or Disposed Expiration Date ---------------- Deriv- ing Re- (D) or Bene- 1. of action if Code of(D) (Month/Day/Year) Amount ative ported In- ficial Title of Deriv- Date any (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity actions (I) ship Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) 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 735 735 (D) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 64 64 (D) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 86 86 (D) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 1,176 1,176 (I) (2) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 102 102 (I) (2) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 138 138 (I) (2) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 107,451 107,451 (I) (3) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 871,427 871,427 (I) (3) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 105,097 105,097 (I) (3) shares ------------------------------------------------------------------------------------------------------------------------------------ Class B Warrants $20/sh(8) 1/27/98 1/27/08 Common 276,240 276,240 (I) (3) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 1,176 1,176 (I) As shares Trustee (4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 102 102 (I) As shares Trustee (4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 137 137 (I) As shares Trustee (4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 11,765 11,765 (I) As shares Trustee (1) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 1,017 1,017 (I) As shares Trustee (1) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 1,372 1,372 (I) As shares Trustee (1) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 588 588 (I) As shares Trustee (5) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 51 51 (I) As shares Trustee (5) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 69 69 (I) As shares Trustee (5) ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 51,177 51,177 (I) (6) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 4,422 4,422 (I) (6) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Commons 5,969 5,969 (I) (6) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 86,147 86,147 (I) (7) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 7,443 7,443 (I) (7) shares ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 10,048 10,048 (I) (7) shares ------------------------------------------------------------------------------------------------------------------------------------ Options (right $20/sh 12/12/97 12/12/07 Common 35,714 35,714 (I) (2) to buy) shares ------------------------------------------------------------------------------------------------------------------------------------ Options (right $25.50/sh 5/4/98 5/4/08 Common 30,714 30,714 (I) (2) to buy) shares ------------------------------------------------------------------------------------------------------------------------------------ Options (right $16.81/sh 2/25/99 2/25/09 Common 70,000 70,000 (I) (2) to buy) shares ------------------------------------------------------------------------------------------------------------------------------------ Options (right $16.50/sh 5/7/99 5/7/09 Common 5,000 5,000 (I) (2) to buy) shares ------------------------------------------------------------------------------------------------------------------------------------ Options (right $5.4375/sh 12/15/99 12/15/09 Common 350,000 350,000 (I) (2) to buy) shares ------------------------------------------------------------------------------------------------------------------------------------ Options (right $4.32380/sh 12/18/01 1/1/11 Common 49,082 49,082 (I) (2) to buy) shares ------------------------------------------------------------------------------------------------------------------------------------
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 20, 2002 ---------------------------------------- ------------------------- **Signature of Reporting Person Date **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. 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