-----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, Feku2GHGajPrI0EdbfLbIdYOCZEcTXQnTW6II14hLCYt5YQmrYwPMuIZ8k4MrZuU X7ebF9AUVv9CcfHSCtynrA== 0000878897-03-000111.txt : 20031204 0000878897-03-000111.hdr.sgml : 20031204 20031204103850 ACCESSION NUMBER: 0000878897-03-000111 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031202 FILED AS OF DATE: 20031204 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: ZIELINSKI THOMAS G CENTRAL INDEX KEY: 0001181962 STATE OF INCORPORATION: VA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13154 FILM NUMBER: 031036673 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 2003-12-02 0 0000878897 AMERICAN MEDICAL SECURITY GROUP INC amz 0001181962 ZIELINSKI THOMAS G C/O AMERICAN MEDICAL SECURITY GROUP INC 3100 AMS BLVD GREEN BAY WI 54313 0 1 0 0 Executive Vice Pres Operations Common Stock 2003-12-02 4 M 0 14500 5.8125 A 18500 D Common Stock 2003-12-02 4 S 0 11900 22.4678 D 6600 D Employee Stock Option (right to buy) 5.8125 2003-12-02 4 M 0 14500 0 D 2011-11-16 Common Stock 14500 53500 D Option vested in four equal annual installments beginning 11/17/2000. /s/ Thomas G. Zielinski 2003-12-04 -----END PRIVACY-ENHANCED MESSAGE-----