-----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, PpHWmVzjpZbaXpq96Cp+UpLdzcHwpkMxOAz5LPkQLRQCQZJsSKL4HnkH1gn36HL1 Ld94h2guOmz/NLdGVQxY8Q== 0000950130-97-004071.txt : 19970918 0000950130-97-004071.hdr.sgml : 19970918 ACCESSION NUMBER: 0000950130-97-004071 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19970911 FILED AS OF DATE: 19970912 SROS: NYSE 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: 4 SEC ACT: SEC FILE NUMBER: 001-10760 FILM NUMBER: 97679689 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 COMPANY DATA: COMPANY CONFORMED NAME: MULDERIG ROBERT A CENTRAL INDEX KEY: 0001045970 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: MUTUAL RISK MANAGEMENT LTD STREET 2: 44 CHURCH STREET CITY: HAMILTON HM12 STATE: D0 ZIP: 00000 BUSINESS PHONE: 4412955688 4 1 FORM 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL WASHINGTON, D.C. 20549 - --------------------------- -------------------------- [ ] CHECK THIS BOX IF NO STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: LONGER SUBJECT TO 3235-0287 SECTION 16. FORM 4 OR Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, EXPIRES: SEPTEMBER FORM 5 OBLIGATIONS MAY Section 17(a) of the Public Utility 30, 1998 CONTINUE. SEE Holding Company Act of 1935 or Section 30(f) of the Investment Company Act ESTIMATED AVERAGE INSTRUCTION 1(B). of 1940 BURDEN HOURS PER RESPONSE 0.5 -------------------------- (Print or Type Responses) - ----------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of 2. Issuer Name AND Ticker or Trading Symbol 6. Relationship of Reporting Person(s) Reporting Person/*/ to Issuer Mutual Risk Management Ltd. (MM) (Check all applicable) Mulderig, Robert A. - ----------------------------------------------------------------------------------- X Director 10% Owner (Last) 3. IRS or Social Security 4. Statement for --- ------ (First) Number of Reporting Month/Year X Officer (give Other (specify (Middle) Person (Voluntary) September 1997 --- title ------ below)/*/ Mutual Risk Management Ltd. below) 44 Church Street Chief Executive Officer ----------------------- - ----------------------------- --------------------------------------------------------------------- (Street) 5. If Amendment, 7. Individual or Joint/Group Date of Original Filing(Check Applicable Line) Hamilton HM 12 Bermuda (Month/Year) X Form filed by One Reporting Person --- Form filed by More than One --- Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) 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 of Disposed of (D) Securities ship of In- Date Code Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 8) Owned at Direct Bene- (Month/ ------------------------------------------- End of Month (D) or ficial Day/ Month (Instr. Indirect Owner- Year) 3 and 4) (I) ship Code V Amount (A) or Price (Instr. 4) (Instr. (D) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Debentures convertible 9/11/97 A 165,195(1) A $50.125 D into Common Stock (See Table II) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 9/11/97 S 190,000 D $50.125 428,189(2) D - ----------------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== Reminder: Report on a separate line for each class of securities (Over) beneficially owned directly or indirectly. SEC 1474 (7-96) /*/If the form is filed by more than one reporting person, see Instruction 4(b)(v).
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security 2. Conversion 3. Transaction 4. Transacation 5. Number of Derivative 6. Date Exercisable (Instr. 3) or Exercise Date Code Securities Acquired (A) and Expiration Price of (Month/Day/ (Instr. 8) or Disposed of (D) Date Derivative Year) (Instr. 3, 4, and 5) (Month/Day/ Security Year) --------------- -------------------------- ------------------- Code V (A) (D) Date Expiration Exer- Date cisable - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- -------- ---------- Convertible Debentures (3) 9/11/97 P $15,350,000 Deben- 1/30/2015 Face tures Amount current- ly con- vertible - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- -------- ---------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- -------- ---------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- -------- ---------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- -------- ---------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- -------- ----------
7. Title and Amount of 8. Price of Derivative 9. Number of Derivative 10. Ownership Form 11. Nature of Indirect Underlying Securities Security (Instr. 5) Securities Beneficially of Derivative Security: Beneficial Ownership (Instr. 3 and 4) Owned at End of Month Direct (D) or (Instr. 4) Instr. 4) Indirect (I) (Instr. 4) - ------------------------ Title Amount or Number of Shares - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ Common Stock 165,161(4) (5) $15,350,000 D Face Amount - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------
Explanation of Responses: (1) Represents Common Shares issuable on conversion of Convertible Debentures. See Table II. (2) Includes 165,161 Common Shares issuable on conversion of Convertible Debentures. Does not include 77,059 shares held indirectly. (3) Each Convertible Debenture is convertible into Common Stock at the rate of 10.759 shares per $1,000 of principal amount at maturity (4) The price per Share of the Common Stock at the time of acquisition of the Convertible Debentures was $50.125. (5) $55.50 per $100 face amount. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). /s/ Robert A. Mulderig 9/12/97 _______________________________ ______________ **Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure. Page 2 SEC 1474 (7-96) 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 Number. -----END PRIVACY-ENHANCED MESSAGE-----