SEC FORM
4
SEC Form 4
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
WHITE MOUNTAINS INSURANCE GROUP LTD
[ WTM ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 06/29/2004
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Common Shares, $1.00 par value
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06/29/2004 |
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C |
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1,724,200 |
A |
$170.51
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1,724,200 |
D
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Warrant (right to buy) |
$170.51
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06/29/2004 |
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C |
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1,724,200 |
06/29/2004 |
06/01/2008 |
Common Shares
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1,724,200 |
$175
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0 |
D
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
BERKSHIRE HATHAWAY INC. |
1440 KIEWIT PLAZA |
(Street)
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Explanation of Responses: |
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/s/ Marc D. Hamburg, Chief Financial Officer on behalf of Berkshire Hathaway Inc. |
07/01/2004 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* If the form is filed by more than one reporting person,
see
Instruction
4
(b)(v). |
** 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. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
rrd38409_43255.html
Joint Filer Information Exhibit 99
Name: Warren E. Buffett
Address: Berkshire Hathaway Inc.
1440 Kiewit Plaza
Omaha, Nebraska 68131
Designated Filer: Berkshire Hathaway Inc.
Issuer & Ticker
Symbol: White Mountains Insurance Group,
Ltd.
Date of Event
Requiring Statement: June 29, 2004
Signature: /s/ Warren E. Buffett
Warren E. Buffett
Name: General Re Corporation
Address: Berkshire Hathaway Inc.
1440 Kiewit Plaza
Omaha, Nebraska 68131
Designated Filer: Berkshire Hathaway Inc.
Issuer & Ticker
Symbol: White Mountains Insurance Group,
Ltd.
Date of Event
Requiring Statement: June 29, 2004
Signature: /s/ William G. Gasdaska
Senior Vice President and CFO
Name: General Reinsurance Corporation
Address: Berkshire Hathaway Inc.
1440 Kiewit Plaza
Omaha, Nebraska 68131
Designated Filer: Berkshire Hathaway Inc.
Issuer & Ticker
Symbol: White Mountains Insurance Group,
Ltd.
Date of Event
Requiring Statement: June 29, 2004
Signature: /s/ Timothy T. McCaffrey
Secretary