5 1 0001.txt U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 5 ANNUAL 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 to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [_] Form 3 Holdings Reported [X] Form 4 Transactions Reported -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Chase Arnold L. -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Chase Enterprises One Commercial Plaza -------------------------------------------------------------------------------- (Street) Hartford CT 06103 -------------------------------------------------------------------------------- (City) (State) (Zip) -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol ACCEL International Corporation (ACLE) -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) N/A -------------------------------------------------------------------------------- 4. Statement for Month/Year January 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 ================================================================================
5. 6. 4. Amount of Owner- Securities Acquired (A) or Securities ship Disposed of (D) Beneficially Form: 7. (Instr. 3, 4 and 5) Owned at End Direct Nature of 2. 3. ----------------------------- of Issuer's (D) or Indirect 1. Transaction Transaction (A) Fiscal Year Indirect Beneficial Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* 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. (Print or Type Responses) (Over) (Form 5-07/99) Page 2 FORM 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
9. 10. Number Owner- of ship 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- Securities Date Securities Price Bene- ity: In- cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock Warrants $2.00 1/20/00 J4 560,000 Immed. 1/20/05 Common 560,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 4/19/00 J4 84,000 Immed. 4/19/05 Common 84,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 4/26/00 J4 56,000 Immed. 4/26/05 Common 56,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 5/4/00 J4 70,000 Immed. 5/4/05 Common 70,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 6/16/00 J4 70,000 Immed. 6/16/05 Common 70,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 6/29/00 J4 18,200 Immed. 6/29/05 Common 18,200 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 7/14/00 J4 168,000 Immed. 7/14/05 Common 168,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 7/14/00 J4 89,824 Immed. 7/14/05 Common 89,824 $0 --- I FN 1 (option to Stock purchase)
Explanation of Responses: **CONTINUED ON NEXT PAGE** Page 3 FORM 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
9. 10. Number Owner- of ship 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- Securities Date Securities Price Bene- ity: In- cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock Warrants $2.00 8/16/00 J4 28,000 Immed. 8/16/05 Common 28,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 8/16/00 J4 28,000 Immed. 8/16/05 Common 28,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 9/07/00 J4 161,000 Immed. 9/07/05 Common 161,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 9/07/00 J4 161,000 Immed. 9/07/05 Common 161,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 9/29/00 J4 28,000 Immed. 9/29/05 Common 28,000 $0 --- I FN 1 (option to Stock purchase) Common Stock Warrants $2.00 12/29/00 J4 31,771 Immed. 12/29/05 Common 31,771 $0 996,147 I FN 1 (option to Stock purchase)
Explanation of Responses: Item 4: Issuer issued warrants to Accel Finance Company LLC, a Connecticut limited liability company ("LLC") to purchase an aggregate of 1,274,971 shares of common stock as a condition to loans made by LLC to Issuer. There was no additional consideration for the warrants. Warrants covering 278,824 shares of Common Stock were assigned by LLC to Chase Dover, Inc., a Delaware corporation ("Chase Dover"), as a condition to loans made by Chase Dover to LLC. LLC used the proceeds of the loans from Chase Dover to fulfill its obligation to loan funds to Issuer. There was no additional consideration for the assignment of warrants from LLC to Chase Dover. FN 1: By membership in LLC; 100% of the warrants held by LLC are reported here, but the reporting person holds less than a 100% interest in LLC and disclaims beneficial ownership of all of the warrants. /s/ Arnold L. Chase 2-14-01 --------------------------------------------- ----------------------- **Signature of Reporting Person Date 2 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. Page 4