-----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, ENOPNKX8aIAmdoZfJvzl05xSTx+DS9s3aIWBsq2tGXhK97qw7lDa/K+f05Z2wHXY PWIEJV8ov7QL/JZYPCVzoA== 0000878897-03-000090.txt : 20030811 0000878897-03-000090.hdr.sgml : 20030811 20030811152258 ACCESSION NUMBER: 0000878897-03-000090 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030807 FILED AS OF DATE: 20030811 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: MODAFF JAMES C CENTRAL INDEX KEY: 0001181964 STATE OF INCORPORATION: VA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13154 FILM NUMBER: 03834396 BUSINESS ADDRESS: STREET 1: C/O AMERICAN MECICAL 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: GREEN BAY STATE: WI ZIP: 54313 4 1 primary_doc.xml PRIMARY DOCUMENT X0201 4 2003-08-07 0 0000878897 AMERICAN MEDICAL SECURITY GROUP INC AMZ 0001181964 MODAFF JAMES C C/O AMERICAN MEDICAL SECURITY GROUP INC 3100 AMS BLVD GREEN BAY WI 54313 0 1 0 0 Exec Vice Pres & Chief Actuary Common Stock 2003-08-07 4 M 0 20000 5.1875 A 20000 D Common Stock 2003-08-07 4 S 0 20000 21.6075 D 0 D Employee Stock Option (right to buy) 5.1875 2003-08-07 4 M 0 20000 0 D 2001-11-17 2012-11-16 Common Stock 20000 35000 D Option vests in four (4) equal installments beginning November 17, 2001. James C. Modaff 2003-08-11 -----END PRIVACY-ENHANCED MESSAGE-----