-----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, PV/7AS/XW2cSyFQdnU7eXWq7S8dIU/VZv9BsRq7m3crEzd4jZvd47QpBRUhMGwVS LrOOEY6XPN8zdpXaBRQBaw== 0001005477-04-001087.txt : 20040304 0001005477-04-001087.hdr.sgml : 20040304 20040304152629 ACCESSION NUMBER: 0001005477-04-001087 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040302 FILED AS OF DATE: 20040304 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LAX MICHAEL CENTRAL INDEX KEY: 0001079805 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10909 FILM NUMBER: 04648779 BUSINESS ADDRESS: STREET 1: C/O MIKASA STREET 2: 20633 S FORDYCE AVENUE CITY: LONG BEACH STATE: CA ZIP: 90810 MAIL ADDRESS: STREET 1: 330 SOUTH SERVICE ROAD STE 120 STREET 2: C/O PHASE III MEDICAL INC CITY: MELVILLE STATE: NY ZIP: 11747 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PHASE III MEDICAL INC/DE CENTRAL INDEX KEY: 0000320017 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE CARRIERS, NEC [6399] IRS NUMBER: 222343568 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 330 SOUTH SERVICE ROAD STREET 2: SUITE 120 CITY: MELVILLE STATE: NY ZIP: 11747 BUSINESS PHONE: 6315744955 MAIL ADDRESS: STREET 1: 330 SOUTH SERVICE ROAD STREET 2: SUITE 120 CITY: MELVILLE STATE: NY ZIP: 11747 FORMER COMPANY: FORMER CONFORMED NAME: CORNICHE GROUP INC /DE DATE OF NAME CHANGE: 19951117 FORMER COMPANY: FORMER CONFORMED NAME: FIDELITY MEDICAL INC DATE OF NAME CHANGE: 19951025 FORMER COMPANY: FORMER CONFORMED NAME: FIDELITY MEDICAL SERVICES INC DATE OF NAME CHANGE: 19830825 3 1 edgar123.xml FORM 3 X0201 3 2004-03-02 0 0000320017 PHASE III MEDICAL INC/DE PHSM 0001079805 LAX MICHAEL C/O PHASE III MEDICAL, INC. 330 SOUTH SERVICE ROAD, SUITE 120 MELVILLE NY 11747 1 0 0 0 Common Stock 0 D Stock Option (right to buy) 0.14 2004-03-02 2014-03-02 Common Stock 300000 D /s/ Michael Lax 2004-03-03 -----END PRIVACY-ENHANCED MESSAGE-----