-----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, V0WRIxjHzzOiZwBSb80gQEe0xqBloubyxrARlzlFYYJ7IUVylzXVlTYWxyVkeepC olMVR7jL9qCFUyFdn3qnnQ== 0000950142-03-000723.txt : 20030415 0000950142-03-000723.hdr.sgml : 20030415 20030415143210 ACCESSION NUMBER: 0000950142-03-000723 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030411 FILED AS OF DATE: 20030415 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: HEAD JOHN C III ET AL CENTRAL INDEX KEY: 0000938236 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4/A BUSINESS ADDRESS: STREET 1: C/O HEAD & CO LLC STREET 2: 1330 AVE OF THE AMERICAS 12TH FL CITY: NEW YORK STATE: NY ZIP: 10019-5412 MAIL ADDRESS: STREET 1: C/O HEAD & CO LLC STREET 2: 1330 AVENUE OF THE AMERICAS 12TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10019-5412 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ESG RE LTD CENTRAL INDEX KEY: 0001049624 STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311] IRS NUMBER: 000000000 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-23481 FILM NUMBER: 03650281 BUSINESS ADDRESS: STREET 1: SKANDIA INTERNATIONAL HOUSE STREET 2: 16 CHURCH STREET, HAMILTON CITY: BERMUDA STATE: D0 BUSINESS PHONE: 4412952185 MAIL ADDRESS: STREET 1: SKANDIA INTERNATIONAL HOUSE STREET 2: 16 CHURCH STREET CITY: BERMUDA STATE: MA ZIP: 11111 4/A 1 form4ahead_041503.txt AMENDMENT ------------------------------ 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(h) 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). (Print or Type Responses) ================================================================================ 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 (ESGREF) ================================================================================ 3. IRS Identification Number of Reporting Person, if any (Voluntary) ================================================================================ 4. Statement for Month/Day/Year 04/09/03 ================================================================================ 5. If Amendment, Date of Original (Month/Day/Year) 04/11/03 ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [X] 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 ================================================================================
5. Amount of 6. 4. Securities Owner- Securities Acquired (A) or Beneficially ship 2. 2A. 3. Disposed of (D) Owned Follow- Form: 7. Transac- Deemed Transaction (Instr. 3, 4 and 5) ing Reported Direct Nature of tion Execution Code ------------------------------- Transac- (D) or Indirect 1. Date Date, if any Instr. 8) (A) tions(s) Indirect Beneficial Title of Security (Month/ (Month/ ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) Day/Year) Day/Year) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value 04/09/03 P 40,000 (A) $0.60 575,517 (D) $1.00 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value 79,914 (I) (1) $1.00 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value 1,087,312 (I) (2) $1.00 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value 109,895 (I) As Trustee $1.00 per share (3) - ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value 5,348 (I) As Trustee $1.00 per share (4) - ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value 383,091 (I) (5) $1.00 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common shares, par value 1,133,088 (I) (6) $1.00 per share - ------------------------------------------------------------------------------------------------------------------------------------
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). PERSONS WHO 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 or 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 action(s) (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 10,736 10,736 (D) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 928 928 (D) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 1,253 1,253 (D) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 107,451 107,451 (I) (2) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 871,427 871,427 (I) (2) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 105,097 105,097 (I) (2) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class B Warrants $18.50/sh 1/27/98 1/27/08 Common 276,240 276,240 (I) (2) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 1,176 1,176 (I) As Trustee shares (3) - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 102 102 (I) As Trustee shares (3) - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 137 137 (I) As Trustee shares (3) - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 588 588 (I) As Trustee shares (4) - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 51 51 (I) As Trustee shares (4) - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 69 69 (I) As Trustee shares (4) - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 51,177 51,177 (I) (5) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/17/97 12/17/07 Common 4,422 4,422 (I) (5) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 5,969 5,969 (I) (5) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/3/97 12/3/07 Common 86,147 86,147 (I) (6) shares - ------------------------------------------------------------------------------------------------------------------------------------
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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 or 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 action(s) (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 12/17/97 12/17/07 Common 7,443 7,443 (I) (6) shares - ------------------------------------------------------------------------------------------------------------------------------------ Class A Warrants $20/sh 12/22/97 12/22/07 Common 10,048 10,048 (I) (6) shares - ------------------------------------------------------------------------------------------------------------------------------------ Options (right $5.4375/sh 12/15/99 12/15/09 Common 174,345 174,345 (D) to buy) shares - ------------------------------------------------------------------------------------------------------------------------------------ Options (right $4.32380/sh 12/18/01 1/1/11 Common 49,082 49,082 (I) (1) to buy) Shares - ------------------------------------------------------------------------------------------------------------------------------------ Options (right $2.1222/sh (7) 1/1/11 Common 368,878 368,878 (D) to buy) shares - ------------------------------------------------------------------------------------------------------------------------------------ Options (right $2.1222/sh (7) 1/1/11 Common 6,122 6,122 (I) (1) to buy) shares - ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: 1. 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. 2. Held by two limited liability companies, of which John C Head III is a Managing Member and a Managing Member of the Managing Member, respectively. 3. Held by the Head Family Foundation. 4. Held by Head Company Pension Plan. 5. Held by a limited partnership, of which John C Head III is the Co-Chief Executive Officer of the General Partner. 6. Held by two limited partnerships, of which John C Head III is a Managing Member of the General Partner. 7. The option vests 50% on 1/15/02, 25% on 1/15/03 and 25% on 1/15/04. /s/ John C Head III April 15, 2003 - ---------------------------------------- ------------------------- **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 3 -----END PRIVACY-ENHANCED MESSAGE-----