-----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, N3aySnhAt6vnYvD4lSl/wfvJ/HBmXtWIlYRXvlP6SMulTtpCgUByDXHOCN+Oe2cc 4LY43TphiX0YZ2p/+nua4A== 0000703701-04-000017.txt : 20040212 0000703701-04-000017.hdr.sgml : 20040212 20040212172904 ACCESSION NUMBER: 0000703701-04-000017 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040212 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ASCENT ASSURANCE INC CENTRAL INDEX KEY: 0000703701 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] IRS NUMBER: 731165000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3100 BURNETT PLAZA STREET 2: 801 CHERRY STREET, UNIT 33 CITY: FORT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: 8178783300 MAIL ADDRESS: STREET 1: 3100 BURNETT PLAZA STREET 2: 801 CHERRY STREET, UNIT 33 CITY: FORT WORTH STATE: TX ZIP: 76102 FORMER COMPANY: FORMER CONFORMED NAME: WESTBRIDGE CAPITAL CORP DATE OF NAME CHANGE: 19920703 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MITCHELL PATRICK J CENTRAL INDEX KEY: 0001278896 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10873 FILM NUMBER: 04593016 MAIL ADDRESS: STREET 1: 3100 BURNETT PLAZA STREET 2: 801 CHERRY STREET CITY: FORT WORTH STATE: TX ZIP: 76102 5 1 primary_doc.xml PRIMARY DOCUMENT X0201 5 2003-12-31 0 0 0 0000703701 ASCENT ASSURANCE INC AASR 0001278896 MITCHELL PATRICK J 3100 BURNETT PLAZA 801 CHERRY STREET FORT WORTH TX 76102 1 1 0 0 Chairman & CEO Common Stock 1999-03-24 5 A 0 18851 0 A 18851 D Common Stock 10209 I 401(k) Plan Common Stock Warrants 9.04 1999-03-24 5 J 0 491 9.04 A 1999-03-24 2004-03-24 Common Stock Warrants 491 491 D Common Stock Options 0.01 1999-06-16 5 A 0 75000 0.01 A 2002-03-24 2009-03-24 Common Stock Options 75000 75000 D Common Stock Options 4.39 1999-06-16 5 A 0 75000 4.39 A 2003-03-24 2009-03-24 Common Stock Options 75000 75000 D Common Stock Options 4.39 1999-06-16 5 A 0 50000 4.39 A 2004-03-24 2009-03-24 Common Stock Options 50000 50000 D Patrick J Mitchell 2004-01-21 -----END PRIVACY-ENHANCED MESSAGE-----