-----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, SH9zjqdtZ2gc3IYwCoVp54+PFaEi+/PO/eIMxZUALe/1gFu4TVFmbSQgr78/yWd/ nkXIlJI9tEuXVLDd0zlGxw== 0001017633-04-000003.txt : 20041222 0001017633-04-000003.hdr.sgml : 20041222 20041222133514 ACCESSION NUMBER: 0001017633-04-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041221 FILED AS OF DATE: 20041222 DATE AS OF CHANGE: 20041222 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BALDWIN & LYONS INC CENTRAL INDEX KEY: 0000009346 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 350160330 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1099 N MERIDIAN ST STREET 2: STE 700 CITY: INDIANAPOLIS STATE: IN ZIP: 46204 BUSINESS PHONE: 3176369800 MAIL ADDRESS: STREET 1: 1099 NORTH MERIDIAN ST STREET 2: STE 700 CITY: INDIANAPOLIS STATE: IN ZIP: 46204 FORMER COMPANY: FORMER CONFORMED NAME: BALDWIN H C AGENCY INC DATE OF NAME CHANGE: 19720309 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PATRICK THOMAS H CENTRAL INDEX KEY: 0001017633 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-05534 FILM NUMBER: 041220021 BUSINESS ADDRESS: BUSINESS PHONE: 1376369800 MAIL ADDRESS: STREET 1: C/O BALDWIN & LYONS INC STREET 2: 1099 NORTH MERIDIAN STREET CITY: INDIANAPOLIS STATE: IN ZIP: 46204 4 1 edgar.xml PRIMARY DOCUMENT X0202 4 2004-12-21 0000009346 BALDWIN & LYONS INC BWINA / B 0001017633 PATRICK THOMAS H 199 EAST LAKE SHORE DRIVE - 7E CHICAGO IL 60611 1 0 0 0 Class A Common 52500 D Class A Common 36375 I Owned by wife of reporting person Class B Common 2004-12-21 4 G 0 218362 27.49 D 8876 D Class B Common 2004-12-21 4 G 0 18500 27.49 D 750 I Owned by wife of reporting person Class B Common 2004-12-21 4 G 0 236862 27.49 A 236862 I Owned by a private foundation Right to buy (option) 1.00 2005-01-02 2014-10-02 Class B Common 815 815 D Reporting person disclaims beneficial ownership of these shares. Shares owned by the foundation were donated by the Reporting Person and his wife, as noted on line items above. Reporting Person is an officer and director of the foundation but has no pecuniary interest in the operations of the foundation and disclaims beneficial ownership of these shares. Options become exercisable one year from the date of issuance and expire ten years and one day from the date of issuance. Exercise price for all options was $1.00 per share on the date of grant. For options previously reported on Forms 4 and 5, the expiration dates range from January 3, 2014 to October 2, 2014. The price paid for the options was equal to and in lieu of directors fees. Thomas H. Patrick 2004-12-22 -----END PRIVACY-ENHANCED MESSAGE-----