-----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, QUDzXcvREYGjl52N2K72p42N+57tgzNm2fvApf4G9bBng0pXxBc+8a1jaXiL7cs6 A1NlWFGJLVHpSAaV+70O3w== 0000878897-03-000109.txt : 20031124 0000878897-03-000109.hdr.sgml : 20031124 20031124163622 ACCESSION NUMBER: 0000878897-03-000109 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031120 FILED AS OF DATE: 20031124 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: MOORE TIMOTHY J CENTRAL INDEX KEY: 0001181965 STATE OF INCORPORATION: VA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13154 FILM NUMBER: 031021043 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 2003-11-20 0 0000878897 AMERICAN MEDICAL SECURITY GROUP INC amz 0001181965 MOORE TIMOTHY J C/O AMERICAN MEDICAL SECURITY GROUP INC 3100 AMS BLVD GREEN BAY WI 54313 0 1 0 0 Sr VP, Gen Counsel, Secretary Common Stock 2003-11-24 4 J 0 236 A 8755.6 I By 401(k) Plan Common Stock 2003-11-20 4 M 0 300 5.1875 A 300 D Common Stock 2003-11-20 4 S 0 300 22.0633 D 0 D Common Stock 2003-11-21 4 M 0 685 5.1875 A 685 D Common Stock 2003-11-21 4 S 0 500 22.024 D 185 D Employee Stock Option (right to buy) 5.1875 2003-06-11 4 G 0 525 0 D 2001-11-17 2012-11-16 Common Stock 525 19475 D Employee Stock Option (right to buy) 5.1875 2003-11-20 4 M 0 300 0 D 2001-11-17 2012-11-16 Common Stock 300 19175 D Employee Stock Option (right to buy) 5.1875 2003-11-21 4 M 0 685 0 D 2001-11-17 2012-11-16 Common Stock 685 18490 D Between 1/12/03 and 11/24/03, the reporting person acquired 236 shares of AMZ common stock under the AMS Retirement Savings Plan, a 401(k) Plan. Such acquisitions, which were not "discretionary transactions" as defined in Rule 16b-3(b), are exempt from Section 16(b) by virtue of Rule 16b-3(c) and are exempt from the reporting requirements of Section 16(a) by virtue of Rule 16a-3(f)(1)(i)(B). Price was between $12.94 and $18.48 per share between 1/12/03 and 11/24/03. Option vests in four (4) equal annual installments beginning 11/17/2001. Timothy J. Moore 2003-11-24 -----END PRIVACY-ENHANCED MESSAGE-----