-----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, EWvYR/2w/cGHCLPXXTItwNV/bDR6HBAN3lz8g5ZgmSM6lD6EiFIKvfM7glbZ71BI iOYLCMe1V5010B2HOQSOkQ== 0000933632-96-000001.txt : 19960606 0000933632-96-000001.hdr.sgml : 19960606 ACCESSION NUMBER: 0000933632-96-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960605 SROS: NYSE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ACCEPTANCE INSURANCE COMPANIES INC CENTRAL INDEX KEY: 0000074783 STANDARD INDUSTRIAL CLASSIFICATION: FINANCE SERVICES [6199] IRS NUMBER: 310742926 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07461 FILM NUMBER: 96576933 BUSINESS ADDRESS: STREET 1: 222 S 15TH ST STREET 2: STE 600 N CITY: OMAHA STATE: NE ZIP: 68102 BUSINESS PHONE: 402-344-88 MAIL ADDRESS: STREET 1: 222 SOUTH 15TH STREET STREET 2: 222 SOUTH 15TH STREET CITY: OMAHA STATE: NE ZIP: 68102 FORMER COMPANY: FORMER CONFORMED NAME: STONERIDGE RESOURCES INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: ORANGE CO INC DATE OF NAME CHANGE: 19870506 FORMER COMPANY: FORMER CONFORMED NAME: NFF CORP DATE OF NAME CHANGE: 19730919 COMPANY DATA: COMPANY CONFORMED NAME: VALASSIS DOUG T CENTRAL INDEX KEY: 0000933632 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR IRS NUMBER: 382706940 STATE OF INCORPORATION: MI FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 1400 N WOODWARD STREET 2: SUITE 270 CITY: BLOOMFIELD HILLS STATE: MI ZIP: 48304 BUSINESS PHONE: 8102582800 MAIL ADDRESS: STREET 1: 520 LAKE COOK RD STREET 2: STE 380 CITY: DEERFIELD STATE: IL ZIP: 60015 4 1 FORM 4 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ___ Check this box if no longer subject STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP to Section 16. Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities Exchange obligations may Act of 1934, Section 17(a) of the Public Utility Holding continue. See Company Act of 1935 or Section 30(f) of the Investment Instruction 1(b). Company Act of 1940 1. Name and Address of Reporting Person 2. Issuer Name and Ticker or 6. Relationship of Reporting Person to Trading Symbol Issuer (Check all applicable) Valassis Doug T. Acceptance Insurance (Last) (First) (Middle) Companies Inc. (AIF) _X_ Director ___ 10% Owner ___ Officer (give ___ Other (specify 3. IRS or Social 4. Statement for title below) Security Month/Year below) Number of 520 Lake Cook Road, Suite 380 Reporting May 1996 (Street) Person (Voluntary) 5. If Amendment, Date of Original (Month/Year) Deerfield IL 60015 (City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature of (Instr. 3) action action or Disposed of (D) Securities ship Indirect Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial (Month/ (Instr. -------------------------- Owned at End Direct Ownership Day/ 8) (A) of Month (D) or (Instr. 4) Year) ---------- or (Instr. 3 Indirect Code V Amount (D) Price and 4) (I) (Instr. 4) - -------------------- ---------- ---- ---- ---------- --- --------- --------------- ------------- ------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly (Print or Type Responses) FORM 4 (continued) Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security 2. Conversion 3. Transaction 4. Transaction 5. Number of Derivative (Instr. 3) or Exercise Date Code Securities Acquired Price of (Month/Day/ (Instr. 8) (A) or Disposed of (D) Derivative Year) (Instr. 3, 4, and 5) Security -------------- ------------------------- Code V (A) (D) - ----------------------------------------- -------------- -------------- ------ ----- ----------- ----------- Incentive Stock Option (Right to Buy) $17.125 5/30/1996 A V 1,500 6. Date Exercisable 7. Title and Amount of Under- 8. Price of 9. Number of 10. Ownership 11. Nature of and Expiration lying Securities Derivative Derivative Form of Indirect Date (Instr. 3 and 4) Security Securities Derivative Beneficial (Month/Day/Year) (Instr. 5) Beneficially Security: Ownership - ---------------------- ----------------------------- Owned at End Direct (D) (Instr. 4) Date Expira- Amount or of Month or Indirect Exer- tion Title Number of (Instr. 4) (I) cisable Date Shares (Instr. 4) - ---------- ---------- ---------------- ----------- ------------- --------------- ---------------- -------------- * 5/30/2006 Common Stock 1,500 6,000 D Explanation of Responses: * Grant to the reporting person an option to buy 1,500 shares of the Company's $.40 par value common stock under the terms and conditions of the Company's 1996 Incentive Stock Option Plan. The option vests at the normal expiration of the reporting person's term as a director of the Company at the next meeting of shareholders at which directors are elected, provided the reporting person remains as a director for such term. The shareholders meeting is tentatively scheduled at or about May 1997. **Intentional misstatements or omissions of facts constitute /s/ Doug T. Valassis 6/5/96 Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. -------------------------------------------- 78ff(a). **Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure.
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