-----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, FhV+I+T7dYSfNtN079oUibS0aFyrkqd6Vop6cglIAsKKP1OJlnISO7ocGtCn1NqZ ydGdJE4gatSdswv6tX+xOg== 0000878897-03-000078.txt : 20030514 0000878897-03-000078.hdr.sgml : 20030514 20030514151629 ACCESSION NUMBER: 0000878897-03-000078 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030512 FILED AS OF DATE: 20030514 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN MEDICAL SECURITY GROUP INC CENTRAL INDEX KEY: 0000878897 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 391431799 STATE OF INCORPORATION: WI FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3100 AMS BLVD CITY: GREEN BAY STATE: WI ZIP: 54313 BUSINESS PHONE: 9206611111 MAIL ADDRESS: STREET 1: 3100 AMS BLVD CITY: GREEN BAY STATE: WI ZIP: 54313 FORMER COMPANY: FORMER CONFORMED NAME: UNITED WISCONSIN SERVICES INC /WI DATE OF NAME CHANGE: 19930328 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BALLOU ROGER H CENTRAL INDEX KEY: 0001158369 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13154 FILM NUMBER: 03698725 BUSINESS ADDRESS: STREET 1: C/O AMERICAN MEDICAL SECURITY GROUP INC STREET 2: 3100 AMS BLVD CITY: GREEN BAY STATE: WI ZIP: 54313 BUSINESS PHONE: 9206611111 MAIL ADDRESS: STREET 1: C/O AMERICAN MEDICAL SECURITY GROUP INC STREET 2: 3100 AMS BLVD CITY: DALLAS STATE: TX ZIP: 75252 4 1 primary_doc.xml PRIMARY DOCUMENT 4 2003-05-12 0 0000878897 AMERICAN MEDICAL SECURITY GROUP INC AMZ 0001158369 BALLOU ROGER H 1 0 0 0 Common Stock 2003-05-12 4 M 0 14000 5.8125 A 16656.42 D Common Stock 2003-05-12 4 M 0 6667 5.1875 A 23323.42 D Common Stock 2003-05-12 4 S 0 20667 17.3006 D 2656.42 D Common Stock 2003-05-14 4 M 0 2000 5.8125 A 4656.42 D Employee Stock Option (Right to Buy) 5.8125 2003-05-12 4 M 0 14000 0 D 2000-11-17 2011-11-16 Common Stock 14000 2000 D Employee Stock Option (Right to Buy) 5.8125 2003-05-14 4 M 0 2000 0 D 2000-11-17 2011-11-16 Common Stock 2000 0 D Employee Stock Option (Right to Buy) 5.1875 2003-05-12 4 M 0 6667 0 D 2001-11-17 2011-11-16 Common Stock 6667 3333 D Option vested in three equal annual installments beginning 11/17/2000. Option vested in three equal annual installments beginning 11/17/2001. /s/ Cheryl A. Thomson (Attorney-in-Fact) 2003-05-14 -----END PRIVACY-ENHANCED MESSAGE-----