-----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, BUvhDVmxzMw4bKi/etGOR/pZoMb/JzBx4p18Ws4F5GerU2wj1GWDv76a7usLRuIu UYIlCJ2fJribAi2CS7mSoA== 0001040490-99-000001.txt : 19990212 0001040490-99-000001.hdr.sgml : 19990212 ACCESSION NUMBER: 0001040490-99-000001 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981231 FILED AS OF DATE: 19990211 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CONSECO INC CENTRAL INDEX KEY: 0000719241 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] IRS NUMBER: 351468632 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 001-09250 FILM NUMBER: 99529796 BUSINESS ADDRESS: STREET 1: 11825 N PENNSYLVANIA ST CITY: CARMEL STATE: IN ZIP: 46032 BUSINESS PHONE: 3178176100 MAIL ADDRESS: STREET 1: 11825 N PENNSYLVANIA ST CITY: CARMEL STATE: IN ZIP: 46032 FORMER COMPANY: FORMER CONFORMED NAME: SECURITY NATIONAL OF INDIANA CORP DATE OF NAME CHANGE: 19840207 COMPANY DATA: COMPANY CONFORMED NAME: ADAMAS JAMES S CENTRAL INDEX KEY: 0001040490 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 11825 N PENNSYLVANIA STREET CITY: CARMEL STATE: IN ZIP: 46032 BUSINESS PHONE: 3178176100 MAIL ADDRESS: STREET 1: 11825 N PENNSYLVANIA STREET CITY: CARMEL STATE: IN ZIP: 46032 5 1 FORM 5 - DECEMBER 31, 1998 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). ( ) Form 3 Holdings Reported ( ) Form 4 Transactions Reported 1. Name and Address of Reporting Person Adams, James S. 11825 N. Pennsylvania Street Carmel, IN 46032 U.S.A. 2. Issuer Name and Ticker or Trading Symbol Conseco, Inc. CNC 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year December 31, 1998 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Senior Vice President, Chief Accounting Officer and Treasurer 7. Individual or Joint/Group Reporting (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. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | |Transaction| or Disposed of (D) | Securities |ect | Beneficial Ownership | |Date |Code| | Beneficially |(D)or | | | | | | A/| | Owned at |Indir | | | | | Amount | D | Price | End of Year |ect(I)| | ___________________________________________________________________________________________________________________________________| Common Stock | | | | | |489,322 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock | | | | | |9,377 |I |By 401(k) Plan | - -----------------------------------------------------------------------------------------------------------------------------------| Preferred Redeemable Increas| | | | | |1,000 |I |By Estate | ed Dividend Equity Securities| | | | | | | | | , | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| 7% PRIDES, Convertible Prefe| | | | | | | | | rred Stock | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Con |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of| Security |version |Transaction rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | |or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise Pr | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership | |ice of | | | posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva | | | |Date |Expir| | |ficially |Ind| | |tive | | | | A/|Exer-|ation| Title and Number | |Owned at |ire| | |Secu | | | | D |cisa-|Date | of Shares | |End of |ct | | |rity | | | Amount | |ble | | | |Year |(I)| | ___________________________________________________________________________________________________________________________________| Options to Purchase |$50.69 |5/14/|A |50,000 |A |5/14/|5/13/|Common Stock|50,000 | |50,000 |D | | | |98 | | | |01 |08 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Options to Purchase |$50.69 |5/14/|A |25,000 |A |5/14/|5/13/|Common Stock|25,000 | |25,000 |D | | | |98 | | | |02 |08 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Options to Purchase |$50.69 |5/14/|A |25,000 |A |5/14/|5/13/|Common Stock|25,000 | |25,000 |D | | | |98 | | | |03 |08 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Options to Purchase (1)| | | | | | | | | | |526,986 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Stock Units (2) |1-for-1 |4/1/9|A |2 |A |(2) |(2) |Common Stock|2 | | |D | | | |8 | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Stock Units (2) |1-for-1 |7/1/9|A |2 |A |(2) |(2) |Common Stock|2 | | |D | | | |8 | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Stock Units (2) |1-for-1 |10/1/|A |2 |A |(2) |(2) |Common Stock|2 | | |D | | | |98 | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Stock Units (2) |1-for-1 |1/4/9|A |3 |A |(2) |(2) |Common Stock|3 | |684 |D | | | |9 | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: (1) Represents stock options held by the Reporting Person as previously reported. (2) Granted under the Conseco, Inc. Deferred Compensation Plan. SIGNATURE OF REPORTING PERSON /s/James S. Adams by Karl W. Kindig, Attorney-in-Fact DATE February 11, 1999 -----END PRIVACY-ENHANCED MESSAGE-----