-----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, NqkDrcHzBym4FJAWgg+tKZhY/QjlPuaunInz2Ezpa+ahcx/ZqELd11tLSuO0j8Mr hdwALRd9qDoCpqJFBzX0Sg== 0000878897-04-000064.txt : 20041214 0000878897-04-000064.hdr.sgml : 20041214 20041214195346 ACCESSION NUMBER: 0000878897-04-000064 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: SKILLERN FRANK CENTRAL INDEX KEY: 0001181984 STATE OF INCORPORATION: VA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13154 FILM NUMBER: 041202989 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 0001181984 SKILLERN FRANK 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 Non-employee director stock option (right to buy) 5.1875 2004-12-13 4 D 0 10000 27.5625 D 2012-11-16 Common Stock 10000 0 D Non-employee director 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 Non-employee director 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 Non-employee director stock option (right to buy) 10.25 2004-12-13 4 D 0 5000 22.5 D 2010-09-27 Common Stock 5000 0 D This option vested in three equal annual installments beginning November 17, 2001. This option vested in three equal annual installments beginning November 29, 2002. This option vested in three equal annual installments beginning January 20, 2004. This option vested in three equal annual installments beginning September 28, 1999. /s/Cheryl A. Thomson Attorney-in-Fact 2004-12-14 -----END PRIVACY-ENHANCED MESSAGE-----