-----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, VPzfjs+OS3II8irPiVoidx2ymIg7D7eB5fMgjRmWAE2GJ9WLtP/WnBV8i9+GEh8A 2DtaUVcf7IRUHCvtNAQmXA== 0000930661-02-000413.txt : 20020414 0000930661-02-000413.hdr.sgml : 20020414 ACCESSION NUMBER: 0000930661-02-000413 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20011231 FILED AS OF DATE: 20020213 COMPANY DATA: COMPANY CONFORMED NAME: DAILEY ROGER E CENTRAL INDEX KEY: 0001137114 DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 4645 PINOT NOIR DRIVE CITY: BRAZELTON STATE: GA ZIP: 30517 MAIL ADDRESS: STREET 1: 4645 PINOT NOIR DRIVE CITY: BRAZELTON STATE: GA ZIP: 30517 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MUTUAL RISK MANAGEMENT LTD CENTRAL INDEX KEY: 0000826918 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 000000000 STATE OF INCORPORATION: D0 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-10760 FILM NUMBER: 02540765 BUSINESS ADDRESS: STREET 1: 44 CHURCH ST STREET 2: BERMUDA CITY: HAMILTON HM 12 BERMU STATE: D0 BUSINESS PHONE: 4412955688 MAIL ADDRESS: STREET 1: PO BOX 2064 STREET 2: BERMUDA CITY: HAMILTON HM HX STATE: D0 ZIP: 1000000000 5 1 d5.txt ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHI /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0362 / / Expires: September 30, 1998 / / Estimated average burden / / hours per response...... 1.0 / /------------------------------/ +--------+ UNITED STATES | FORM 5 | SECURITIES AND EXCHANGE COMMISSION +--------+ Washington, D.C. 20549 [_] Check this box if no longer subject ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP to Section 16. Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities obligations may Exchange Act of 1934, Section 17(a) of the continue. See Public Utility Holding Company Act of 1935 or Instruction 1(b). Section 30(f) of the Investment Company Act of 1940 [_] Form 3 Holdings Reported [_] Form 4 Transactions Reported - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Dailey, Roger E. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 4645 Pinot Noir Drive - -------------------------------------------------------------------------------- (Street) Brazelton GA 30517 - -------------------------------------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol Mutual Risk Management Ltd. (MM) ----------------------------------- 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) -------------- 4. Statement for Month/Year December 31, 2001 --------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) -------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [X] Director [_] Officer [_] 10% Owner [_] Other (give title below) (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
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action or Disposed of (D) Securities ship of In- Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 8) Owned at the Direct Bene- (Month/ end of (D) or ficial Day/ Issuer's Indirect Owner- Year) (A) or Fiscal Year (I) ship Amount (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 04/17/01 A 1,189 A D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 07/03/01 A 967 A D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 10/01/01 A 1,156 A 38,945 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
* If the form is filed by more than one reporting person, see instruction 4(b)(v). Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. (Over) SEC 2270(7-97) FORM 5 (continued) Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g. puts, calls, warrants, options, convertible securities)
- ----------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- Security (Instr. 3) sion or action tion Code ative Securities Exercise Date (Instr. 8) Acquired (A) or Price of (Month/ Disposed of (D) Deriv- Day/ (Instr. 3, 4, and 5) ative Year) Security --------------------------- (A) (D) - ------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option $ 8.960000 12/03/01 A 15,000 (right to buy) - ------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option $14.750000 (right to buy) - ------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option $16.500000 (right to buy) - ------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option $27.812500 (right to buy) - ------------------------------------------------------------------------------------------------------------------------------ Non-Qualified Stock Option $37.250000 (right to buy) - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na- cisable and Underlying Securities of of Deriv- ship Form ture Expiration (Instr. 3 and 4) Deriv- ative of De- of In- Date ative Secur- rivative direct (Month/Day/ Secur- ities Secu- Bene- Year) ity Bene- rity: ficial (Instr. 5) ficially Direct Owner- -------------------------------------------- Owned (D) or ship Date Expira- Amount or at End Indi- (Instr. 4) Exer- tion Title Number of of Year rect (I) cisable Date Shares (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ 12/03/06 Common Stock 15,000 15,000 D - ------------------------------------------------------------------------------------------------------------------------------------ 12/01/04 Common Stock 7,500 7,500 D - ------------------------------------------------------------------------------------------------------------------------------------ 12/01/05 Common Stock 15,000 15,000 D - ------------------------------------------------------------------------------------------------------------------------------------ 12/01/02 Common Stock 7,500 7,500 D - ------------------------------------------------------------------------------------------------------------------------------------ 12/01/03 Common Stock 7,500 7,500 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal -------------------------------- ----------------- Criminal Violations. **Signature of Reporting Person Date 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. Potential persons who are to respond to the collection of information contained in this form are not reguired to respond unless the form displays a currently valid OMB Number. Page 2 SEC 2270 (7-97) -----END PRIVACY-ENHANCED MESSAGE-----