SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
OBERST STEPHEN J

(Last) (First) (Middle)
307 NORTH MICHIGAN AVENUE
SUITE 2300

(Street)
CHICAGO IL 60601

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/01/2019
3. Issuer Name and Ticker or Trading Symbol
OLD REPUBLIC INTERNATIONAL CORP [ ORI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Executive Vice President
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 2,257 D
Common Stock 15,858 I By ESSOP
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
2011 Employee Stock Option 12/31/2011(1) 03/23/2021 Common Stock 10,710 12.33 D
2012 Employee Stock Option 12/31/2012(1) 03/20/2022 Common Stock 14,000 10.8 D
2013 Employee Stock Option 12/31/2013(1) 03/20/2023 Common Stock 11,000 12.57 D
2014 Employee Stock Option 12/31/2014(1) 03/19/2024 Common Stock 12,000 16.06 D
2015 Employee Stock Option 12/31/2015(1) 03/19/2025 Common Stock 14,500 15.26 D
2016 Employee Stock Option 12/31/2016(1) 03/23/2026 Common Stock 16,000 18.14 D
2017 Employee Stock Option 12/31/2017(1) 03/22/2027 Common Stock 21,000 19.98 D
2018 Employee Stock Option 12/31/2018(1) 02/20/2028 Common Stock 24,000 20.98 D
2019 Employee Stock Option 12/31/2019(1) 03/19/2029 Common Stock 28,000 21.12 D
2019 Employee Stock Option(a) 12/31/2019(1) 08/20/2029 Common Stock 15,000 21.99 D
Explanation of Responses:
1. These shares vest and become exercisable each December 31 at the rate of 10% the first year, 15% the second year, 20% the third year, 25% the fourth year and 30% the fifth year. Also, vesting shall accelerate if the optionee dies, becomes disabled, retires or a change of control of the company occurs. For those optionees over age 65 and who have been employed for 10 years or more by the company on the date of the grant, 100% of the option shares vest immediately.
Remarks:
John R. Heitkamp, Power of Attorney for Stephen J. Oberst 10/09/2019
** 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 5 (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.
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