Annual Statement of Changes in Beneficial Ownership (5)
January 08 2020 - 12:33PM
Edgar (US Regulatory)
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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).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0362
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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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1. Name and Address of Reporting Person
*
DEW JIMMY A | 2. Issuer Name and Ticker or Trading SymbolOLD REPUBLIC INTERNATIONAL CORP [ORI] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
307 NORTH MICHIGAN AVENUE | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2019 |
(Street)
CHICAGO, IL 60601
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Amount | (A) or (D) | Price |
Common Stock | | | | | | | 336067 | D | |
Common Stock | | | | | | | 315908 | I | By Spouse |
Common Stock | | | | | | | 93682 | I | By IRA |
Common Stock | 12/31/2019 (1) | | J (1) | 688 | A | $0 | 122937 | I | By 401-K |
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 Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (MM/DD/YYYY) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | This filing reflects an adjustment caused by the provision of the Internal Revenue Code that requires minimum annual distributions from a 401-K account. The Reporting Person is entitled to a certain percentage of the assets held in a pooled retirement account, which holds shares of ORI Common Stock (the 401-K account). The number of shares held by the Reporting Person in the 401-K account is calculated by dividing the funds attributable to the Reporting Person by the share price of ORI Common Stock at any determination date. Although the Reporting Person received the required distribution mandated by the Internal Revenue Code, there was an increase in the value of the assets attributable to the Reporting Person in the 401-K account. That increase is expressed as the indicated additional shares of ORI Common Stock. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
DEW JIMMY A 307 NORTH MICHIGAN AVENUE CHICAGO, IL 60601 | X |
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Signatures
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William J. Dasso, Power of Attorney for Jimmy A. Dew | | 1/7/2020 |
**Signature of Reporting Person | Date |
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