-----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, FrTlhE0J90d4LdglSE6IH74j9jzxZJ3cdJiJdKQbJYjajx73fV2B/oulYZbyI/kE 21VB6SPJlWDL/mL4OjzT8w== 0000878897-04-000074.txt : 20041215 0000878897-04-000074.hdr.sgml : 20041215 20041215162530 ACCESSION NUMBER: 0000878897-04-000074 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041213 FILED AS OF DATE: 20041215 DATE AS OF CHANGE: 20041215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILLER SAMUEL V CENTRAL INDEX KEY: 0001081113 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13154 FILM NUMBER: 041205152 BUSINESS ADDRESS: BUSINESS PHONE: 9206615418 MAIL ADDRESS: STREET 1: AMERICAN MEDICAL 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 0001081113 MILLER SAMUEL V AMERICAN MEDICAL SECURITY GROUP INC 3100 AMS BLVD GREEN BAY WI 54313 1 1 0 0 Chairman, President & CEO Common Stock 2004-12-13 4 D 0 105006 32.75 D 0 D Employee Stock Option (right to buy) 11.71 2004-12-13 4 D 0 427205 21.04 D 2007-10-31 Common Stock 427205 0 D Employee Stock Option (right to buy) 10.25 2004-12-13 4 D 0 87000 22.5 D 2010-09-27 Common Stock 87000 0 D Employee Stock Option (right to buy) 12.25 2004-12-13 4 D 0 101113 20.5 D 1998-11-17 2010-11-16 Common Stock 101113 0 D Employee Stock Option (right to buy) 5.8125 2004-12-13 4 D 0 37000 26.9375 D 2011-11-16 Common Stock 37000 0 D Employee Stock Options (right to buy) 5.1875 2004-12-13 4 D 0 100000 27.5625 D 2012-11-16 Common Stock 100000 0 D Employee Stock Option (right to buy) 12.25 2004-12-13 4 D 0 160000 20.5 D 2014-01-09 Common Stock 160000 0 D Employee Stock Option (right to buy) 14.41 2004-12-13 4 D 0 135500 18.34 D 2015-01-19 Common Stock 135500 0 D This option became fully vested September 28, 1998. This option vested in four equal annual installments beginning September 28, 1999. This option vested in four equal annual installments beginning November 17, 2000. This option vested in four equal annual installments beginning November 17, 2001. This option vested in four equal annual installments beginning January 10, 2003. This option vested in four equal annual installments beginning January 20, 2004. /s/Cheryl A. Thomson Attorney-in-Fact 2004-12-15 -----END PRIVACY-ENHANCED MESSAGE-----