-----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, Hm+qJwOSSKYTdXOi4wHpPNmiR/cSjTdGYOZd432hnc7GmWj+ricmod3c8nQB36Hb /tKGYshGqM3mDlincX4+Hw== 0000818155-96-000007.txt : 19960207 0000818155-96-000007.hdr.sgml : 19960207 ACCESSION NUMBER: 0000818155-96-000007 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960206 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: WALSHIRE ASSURANCE COMPANY CENTRAL INDEX KEY: 0000818155 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 232023240 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-39229 FILM NUMBER: 96511898 BUSINESS ADDRESS: STREET 1: 3350 WHITEFORD RD STREET 2: PO BOX 3849 CITY: YORK STATE: PA ZIP: 17402 BUSINESS PHONE: 7177570000 MAIL ADDRESS: STREET 1: 3350 WHITEFORD RD STREET 2: PO BOX 3849 CITY: YORK STATE: PA ZIP: 174020138 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: WALSHIRE ASSURANCE COMPANY CENTRAL INDEX KEY: 0000818155 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 232023240 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 3350 WHITEFORD RD STREET 2: PO BOX 3849 CITY: YORK STATE: PA ZIP: 17402 BUSINESS PHONE: 7177570000 MAIL ADDRESS: STREET 1: 3350 WHITEFORD RD STREET 2: PO BOX 3849 CITY: YORK STATE: PA ZIP: 174020138 SC 13G/A 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. 3)* WALSHIRE ASSURANCE COMPANY (Name of Issuer) COMMON STOCK, PAR VALUE $.01 PER SHARE (Title of Class of Securities) 933132102 (CUSIP Number) Check the following box if a fee is being paid with this statement. (A fee is not required only if the filing person: (1) has a previous statement on file reporting beneficial ownership of more than five percent of the class of securities described in Item 1; and (2) has filed no amendment subsequent thereto reporting beneficial ownership of five percent or less of such class.) (See Rule 13d-7). *The remainder of this cover page shall be filled out for a reporting person s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. The information required in the remainder of this cover page shall not be deemed to be filed for the purpose of Section 18 of the Securities Exchange Act of 1934 ( Act ) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). Page 1 of 5 pages SEC 1745 (2/92) CUSIP No. 933132102 13G Page 2 of 5 Pages 1 NAME OF REPORTING PERSON S.S. or I.R.S. IDENTIFICATION NO. OF ABOVE PERSON L. Edward Sausman ###-##-#### 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) (b) x 3 SEC USE ONLY 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States 5 SOLE VOTING POWER NUMBER OF 246,014 Shares (See Note 1 to Item 4) SHARES BENEFICIALLY 6 SHARED VOTING POWER OWNED 9,972 Shares (See Notes 2 and 3 to Item 4) BY EACH 7 SOLE DISPOSITIVE POWER REPORTING 246,014 Shares (See Note 1 to Item 4) PERSON WITH 8 SHARED DISPOSITIVE POWER 9,972 Shares (See Notes 2 and 3 to Item 4) 9 AGGREGATE AMOUNT BENEFICALLY OWNED BY EACH REPORTING PERSON 255,986 Shares (See Notes 1, 2 and 3 to Item 4) 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 6.23% (See Note 4 to Item 4) 12 TYPE OF REPORTING PERSON* In *SEE INSTRUCTION BEFORE FILLING OUT! CUSIP No. 933132102 13G Page 3 of 5 Pages 1 NAME OF REPORTING PERSON S.S. or I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Beverly G. Sausman ###-##-#### 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) (b) x 3 SEC USE ONLY 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States 5 SOLE VOTING POWER NUMBER OF 9,691 Shares (See Note 3 to Item 4) SHARES BENEFICIALLY 6 SHARED VOTING POWER OWNED 246,295 Shares (See Notes 1 and 2 to Item 4) BY EACH 7 SOLE DISPOSITIVE POWER REPORTING 9,691 Shares (See Note 3 to Item 4) PERSON WITH 8 SHARED DISPOSITIVE POWER 246,295 Shares (See Notes 1 and 2 to Item 4) 9 AGGREGATE AMOUNT BENEFICALLY OWNED BY EACH REPORTING PERSON 255,986 Shares (See Notes 1, 2 and 3 to Item 4) 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 6.23% (See Note 4 to Item 4) 12 TYPE OF REPORTING PERSON* In *SEE INSTRUCTION BEFORE FILLING OUT! Item 1. Name and Address of Issuer. (a) This Statement relates to the common stock, par value $.01 per share (the Common Stock ), of Walshire Assurance Company (the Company ). (b) The Company s principal executive offices are located at 3350 Whiteford Road, P. O. Box 3849, York, PA 17402-0138. Item 2. Name, Address and Citizenship of Person Filing, Title of Class of Securities and CUSIP Number. (a) This Statement is filed by L. Edward Sausman, Jr. and Beverly G. Sausman. (b) The address of Mr. and Mrs. Sausman s business office is P. O. Box 158, Thompsontown, PA 17094. (c) Mr. and Mrs. Sausman are citizens of the United States. (d) Title of Class of Securities: Common Stock, par value $.01 per shares. (e) CUSIP Number: 933132102. Item 3. Statement Filed Pursuant to Rules 13d-1(b) or 13d-2(b). Not Applicable. Item 4. Ownership. (a) Items 5, 7, 8, 9 and 11 from Pages 2 and 3 of this Statement are incorporated by reference. The filing of this Statement shall not be construed as an admission that the reporting person is for the purpose of Section 13(d) or 13(g) of the Securities Exchange Act of 1934, as amended, the beneficial owner of any of the securities covered by this Statement. Note 1. Such amount includes: (i) 200,393 shares of Common Stock which are owned individually by Mr. Sausman, Jr. and (ii) 45,621 shares of Common Stock which are issuable pursuant to options granted to Mr. Sausman, Jr. which are exercisable within 60 days from the date of this Statement. Note 2. Such amount represents 281 shares of Common Stock owned individually by L. Edward Sausman, Jr. and Beverly G. Sausman. Note 3. Such amount represents 9,691 shares of Common Stock owned individually by Mrs. Sausman. PAGE 4 OF 5 Note 4. This percentage is obtained by dividing the amount of shares of Common Stock beneficially owned by Mr. and Mrs. Sausman, Jr. by the sum of (i) 4,064,423 shares of Common Stock, the number of issued and outstanding shares of common stock as of the most recent practicable date and (ii) 45,621 shares of Common Stock which are issuable as described in Note 1 above. Item 5. Ownership of Five Percent or Less of a Class. Not Applicable. Item 6. Ownership of More than Five Percent on Behalf of Another Person. Not Applicable. Item 7. Identification and Classification of the Subsidiary which Acquired the Security being Reported on by the Parent Holding Company. Not Applicable. Item 8. Identification and Classification of Members of the Group. Not Applicable. Item 9. Notice of Dissolution of Group. Not Applicable. Item 10. Certification. Not Applicable. Signature. After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this Statement is true, complete and correct. Dated: January 23, 1996 /s/ L. Edward Sausman, Jr. /s/ Beverly G. Sausman PAGE 5 OF 5 -----END PRIVACY-ENHANCED MESSAGE-----