-----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, ExedhuoV4yZdKczxVXSjTut5Rx2HA4mV8zIU8RczNfKmWvsZDQ+c4PHymWzn+Pc1 07yE1ogpcRItfh2oFjphww== 0000878897-04-000058.txt : 20041214 0000878897-04-000058.hdr.sgml : 20041214 20041214180653 ACCESSION NUMBER: 0000878897-04-000058 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041213 FILED AS OF DATE: 20041214 DATE AS OF CHANGE: 20041214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRENNAN W FRANCIS CENTRAL INDEX KEY: 0001181977 STATE OF INCORPORATION: VA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13154 FILM NUMBER: 041202796 BUSINESS ADDRESS: BUSINESS PHONE: 9206611111 MAIL ADDRESS: STREET 1: C/O AMERICAN MECICAL SECURITY GROUP INC STREET 2: 3100 AMS BLVD CITY: GREEN BAY STATE: WI ZIP: 54313 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0202 4 2004-12-13 1 0000878897 AMERICAN MEDICAL SECURITY GROUP INC AMZ 0001181977 BRENNAN W FRANCIS C/O AMERICAN MECICAL SECURITY GROUP INC 3100 AMS BLVD GREEN BAY WI 54313 1 0 0 0 Common Stock 2004-12-13 4 D 0 12300 32.75 D 0 D Employee stock option (right to buy) 10.2 2004-12-13 4 D 0 8000 22.55 D 2013-11-28 Common Stock 8000 0 D Employee stock option (right to buy) 14.41 2004-12-13 4 D 0 6700 18.34 D 2015-01-19 Common Stock 6700 0 D This option vests in three equal annual installments beginning November 29, 2002 This option vests in three equal annual installments beginning January 20, 2004. /s/Cheryl A. Thomson Attorney-in-Fact 2004-12-14 -----END PRIVACY-ENHANCED MESSAGE-----