-----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, A7djEv7FfrVSyU10POk476kWRhI5/Wzh0pFLLhEFWVIuVKQnZu7KChMI4JFNTz5P YbliiWcUD8NdhR1VWhxLQg== 0000950150-98-001678.txt : 19981103 0000950150-98-001678.hdr.sgml : 19981103 ACCESSION NUMBER: 0000950150-98-001678 CONFORMED SUBMISSION TYPE: 8-A12G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19981102 FILER: COMPANY DATA: COMPANY CONFORMED NAME: SUPERIOR NATIONAL INSURANCE GROUP INC CENTRAL INDEX KEY: 0000810463 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 954610936 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 8-A12G SEC ACT: SEC FILE NUMBER: 000-25984 FILM NUMBER: 98736318 BUSINESS ADDRESS: STREET 1: 26601 AGOURA RD STREET 2: ` CITY: CALABASAS STATE: CA ZIP: 91302 BUSINESS PHONE: 8188801600 MAIL ADDRESS: STREET 1: 26601 AGOURA ROAD CITY: CALABASAS STATE: CA ZIP: 91302 8-A12G 1 FORM 8-A 1 ================================================================================ SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ---------- FORM 8-A ---------- FOR REGISTRATION OF CERTAIN CLASSES OF SECURITIES PURSUANT TO SECTION 12(b) OR 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934 SUPERIOR NATIONAL INSURANCE GROUP, INC. (Exact Name of Registrant as Specified in Its Charter) DELAWARE 95-4610936 (State of Incorporation or Organization) (I.R.S. Employer Identification No.) 26601 AGOURA ROAD 91302 CALABASAS, CALIFORNIA (Zip Code) (Address of Principal Executive Offices)
---------- SECURITIES TO BE REGISTERED PURSUANT TO SECTION 12(b) OF THE ACT: None If this form relates to the registration of a class of securities pursuant to Section 12(b) of the Exchange Act and is effective pursuant to General Instruction A.(c), check the following box. [ ] If this form relates to the registration of a class of securities pursuant to Section 12(g) of the Exchange Act and is effective pursuant to General Instruction A.(d), check the following box. [X] Securities Act registration statement file number to which this form relates: 333-58579 ---------- SECURITIES TO BE REGISTERED PURSUANT TO SECTION 12(g) OF THE ACT: Subscription Right to Purchase Common Stock, par value $0.01 per share -------------------------------------- (Title of Class) ================================================================================ 2 ITEM 1. DESCRIPTION OF REGISTRANT'S SECURITIES TO BE REGISTERED. The description of the Registrant's Subscription Right to Purchase Common Stock, par value $0.01 per share, being offered pursuant to the Stock Offering, as defined in the Registrant's Amendment No. 1 to Form S-3 on Form S-1 (Registration No. 333-58579), as filed on October 21, 1998, as the same may be amended from time to time (the "S-3 Registration Statement"), is contained on pages 54 through 62 of the prospectus which forms a part of the S-3 Registration Statement, under the caption "The Stock Offering," is incorporated herein by this reference. ITEM 2. EXHIBITS. The following Exhibits are filed as part of this Registration Statement: 1. Registrant's S-3 Registration Statement (incorporated by reference); 2. Form of Subscription Certificate to be used in the Rights Offering (incorporated by reference to Exhibit 99.1 of the S-3 Registration Statement); 3. Form of Subscription Certificate to be used in the Employee Participation (incorporated by reference to Exhibit 99.2 of the S-3 Registration Statement); 4. Form of Employee Participation Agreement to be used in the Employee Participation (incorporated by reference to Exhibit 99.3 of the S-3 Registration Statement); 5. Form of Stock Subscription Agreement to be used in the Employee Participation (incorporated by reference to Exhibit 99.4 of the S-3 Registration Statement); 6. Form of Securities Pledge Agreement to be used in the Employee Participation (incorporated by reference to Exhibit 99.5 of the S-3 Registration Statement); and 7. Form of Promissory Note to be used in the Employee Participation (incorporated by reference to Exhibit 99.6 of the S-3 Registration Statement). 2. 3 SIGNATURE Pursuant to the requirements of Section 12 of the Securities Exchange Act of 1934, the Registrant has duly caused this registration statement to be signed on its behalf by the undersigned, thereto duly authorized. SUPERIOR NATIONAL INSURANCE GROUP, INC. Dated: November 2, 1998 By: /s/ J. Chris Seaman -------------------------------------- J. Chris Seaman Executive Vice President and Chief Financial Officer 3. -----END PRIVACY-ENHANCED MESSAGE-----