-----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, CRnejeUWOYNqxSmkHGVPV0qoCkrkT0Uou7nkg3Xc+13J5zuaL3KP8Xz8Buss4Iy6 ikIcSaH7SlTIXihsxnKlbg== 0000950123-98-000186.txt : 19980113 0000950123-98-000186.hdr.sgml : 19980113 ACCESSION NUMBER: 0000950123-98-000186 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19971115 FILED AS OF DATE: 19980112 SROS: NONE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ICH CORP /DE/ CENTRAL INDEX KEY: 0000049588 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] IRS NUMBER: 436069928 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 001-07697 FILM NUMBER: 98505235 BUSINESS ADDRESS: STREET 1: 9404 GENESEE AVE CITY: LA JOLLA STATE: CA ZIP: 92037 BUSINESS PHONE: 2149547111 MAIL ADDRESS: STREET 1: P.O. BOX 2699 STREET 2: SUITE 400 CITY: DALLAS STATE: TX ZIP: 75221 FORMER COMPANY: FORMER CONFORMED NAME: SOUTHWESTERN LIFE CORP DATE OF NAME CHANGE: 19940808 FORMER COMPANY: FORMER CONFORMED NAME: ICH CORP DATE OF NAME CHANGE: 19930506 FORMER COMPANY: FORMER CONFORMED NAME: ICH CORP/CONSOL NAT/RTS/CFR/MOD AMER LIFE INS/SW LIFE INS/CF DATE OF NAME CHANGE: 19930505 COMPANY DATA: COMPANY CONFORMED NAME: MILLER LLOYD I III CENTRAL INDEX KEY: 0000949119 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 4650 GORDON DRIVE CITY: NAPLES STATE: FL ZIP: 33940 BUSINESS PHONE: 9412628577 3 1 FORM 3 1 --------------------------- OMB APPROVAL --------------------------- - -------- OMB Number: 3235-0104 FORM 3 Expires: September 30, 1998 - -------- Estimated average burden hours per response .... 0.5 --------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 - ----------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Person 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Miller, III Lloyd I. Statement Trading Symbol of Original - ---------------------------------------- (Month/Day/Year) I.C.H. Corporation (IH) (Month/Day/Year) (Last) (First) (Middle) November 15, 1997 (1) ------------------------------ 4550 Gordon Drive ---------------------------- 5. Relationship of Reporting 7. Individual or Joint/ - ---------------------------------------- 3. IRS or Social Security Person to Issuer Group Filing (Check (Street) Number of Reporting (Check all applicable) Applicable Line) Person (Voluntary) ___ Director X 10% Owner X Form filed by One Naples FL 34102 ###-##-#### ___ Officer ___ Other Reporting Person - -------------------------------------- ---------------------------- (give title below) (specify below) __ Form filed by More (City) (State) (Zip) than One Reporting --------------------------- Person - ----------------------------------------------------------------------------------------------------------------------------------- TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 3,000(2) I By Trust A-1 - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 16,100(2) I By Trust A-3 - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 93,198(2) I By Trust A-4 - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 34,100(2) I By Trust C - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 155,982 D - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses) SEC 1473 (8/92)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deri- ative vative Security: Security Direct ------------------------------------------------- (D) or Date Expira- Amount or Indirect (I) Exercis- tion Title Number (Instr. 5) able Date of Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) On November 14, 1997, I.C.H. Corporation filed its form 10-Q for the period ending September 30, 1997. In that report, the company reported the number of its outstanding shares as 2,297,023, a decrease from the 2,793,550 number reported in the company's previous 10-Q. (2) The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. /s/ Lloyd I. Miller, III 1/12/98 **Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- ------------- Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date Note. File three copies of this Form, one of which must be manually signed. Page 2 If space provided is insufficient, See Instruction 6 for procedure. SEC 1473 (8/92)
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