-----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, DsBrkO/UV4JlfgC7xHUTEGQkJAT4Ngv4YWFPQm8vn0Ax1EA9ebeoal5wgLzKx1XZ xf5Uy/gwNWuH8cCDQvh0lQ== 0000950123-98-000871.txt : 19980205 0000950123-98-000871.hdr.sgml : 19980205 ACCESSION NUMBER: 0000950123-98-000871 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19970131 FILED AS OF DATE: 19980204 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: 4 SEC ACT: SEC FILE NUMBER: 001-07697 FILM NUMBER: 98521013 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: 4 BUSINESS ADDRESS: STREET 1: 4650 GORDON DRIVE CITY: NAPLES STATE: FL ZIP: 33940 BUSINESS PHONE: 9412628577 4 1 FORM 4 1 - ------ -------------------------------- FORM 4 OMB APPROVAL - ------ -------------------------------- [ ] Check this box if no longer OMB Number 3235-0287 subject to Section 16 Form 4 or Expires: September 30, 1998 Form 5 obligations may continue. Estimated average burden See Instruction 1(b). hours per response ......... 0.5 -------------------------------- 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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 (Print or Type Responses) - ----------------------------------------------------------- 1. Name and Address of Reporting Person* Miller, III Lloyd I -------------------------------------------- (Last) (First) (Middle) 4550 Gordon Drive -------------------------------------------- (Street) Naples FL 34102 -------------------------------------------- (City) (State) (Zip) - ----------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol I.C.H. Corporation (IH) - ----------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) ###-##-#### - ----------------------------------------------------------- 4. Statement for Month/Year January, 1997 - ----------------------------------------------------------- 5. If Amendment, Date or Original (Month/Year) - ----------------------------------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director X 10% Owner ----- ----- Officer (give Other (specify ----- title below) ----- below) -------------------------- - ----------------------------------------------------------- 7. 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 Acquired, Disposed of or Beneficially Owned
- ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action or Disposed of (D) Securities ship of Indirect Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial (Instr. 8) Owned at Direct Owner- (Month/ End of Month (D) or ship Day/ ------------------------------------------ Indirect Year) (A) or (I) Code V Amount (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 1/8/97 P 200(1) A $3.59 302,580 I By Trust A-4 - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of (Over) securities beneficially owned directly or indirectly. SEC 1474(7-96) *If the form is filed by more than one reporting person, see Instruction 4(b)(v). Page 1 of 2 2 FORM 4 (CONTINUED) TABLE II--DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. TITLE OF DERIVATIVE SECURITY 2. CONVERSION 3. TRANSACTION 4. TRANSACTION 5. NUMBER OF DERIVATIVE 6. DATE EXERCISABLE (INSTR. 3) OR EXERCISE DATE (MONTH/ CODE (INSTR. 8) SECURITIES ACQUIRED (A) AND EXPIRATION PRICE OF DAY/YEAR) OR DISPOSED OF (D) DATE (MONTH/DAY/ DERIVATIVE (INSTR. 3, 4, AND 5) YEAR) SECURITY ------------------- DATE ---------------------------------------------- EXER- EXPIRATION CODE V (A) (D) CISABLE DATE - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
7. TITLE AND AMOUNT OF 8. PRICE OF 9. NUMBER OF 10. OWNERSHIP 11. NATURE OF UNDERLYING SECURITIES DERIVATIVE DERIVATIVE FORM OF INDIRECT (INSTR. 3 AND 4) SECURITY SECURITIES DERIVATIVE BENEFICIAL (INSTR. 5) BENEFICIALLY SECURITY: OWNERSHIP OWNED AT END DIRECT (D) (INSTR. 4) OF MONTH INDIRECT (I) (INSTR. 4) (INSTR. 4) - -------------------------- AMOUNT OR TITLE NUMBER OF SHARES - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: (1) The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. ** 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. /s/ Lloyd I. Miller, III 2/4/98 - ------------------------------------- -------------------------- **Signature of Reporting Person Date Page 2 SEC 1474 (7-96) Page 2 of 2 -----END PRIVACY-ENHANCED MESSAGE-----