WIRCH JOHN R 4

4 · AMERICAN MEDICAL SECURITY GROUP INC · Filed Dec 15, 2004

Form 4

Period: 2004-12-13

VP, Human Resources

Transactions

Disposition to Issuer
Employee Stock Option (Right to Buy)
2004-12-13$22.50/sh−15,000$337,500→ 0 total
Exercise: $10.25Exp: 2010-09-27→ Common Stock (15,000 underlying)
Disposition to Issuer
Employee Stock Option (right to buy)
2004-12-13$18.34/sh−10,000$183,400→ 0 total
Exercise: $14.41Exp: 2015-01-19→ Common Stock (10,000 underlying)
Disposition to Issuer
Employee Stock Option (right to buy)
2004-12-13$26.94/sh−13,000$350,188→ 0 total
Exercise: $5.81Exp: 2011-11-16→ Common Stock (13,000 underlying)
Disposition to Issuer
Employee Stock Option (right to buy)
2004-12-13$27.56/sh−15,000$413,438→ 0 total
Exercise: $5.19Exp: 2012-11-16→ Common Stock (15,000 underlying)
Disposition to Issuer
Common Stock
2004-12-13$32.75/sh−1,000$32,750→ 0 total
Disposition to Issuer
Employee Stock Option (right to buy)
2004-12-13$22.55/sh−12,000$270,600→ 0 total
Exercise: $10.20Exp: 2013-11-28→ Common Stock (12,000 underlying)

Footnotes (5)

[F1]This option vested in four equal annual installments beginning September 28, 1999.
[F2]This option vested in four equal annual installments beginning November 17, 2000.
[F3]This option vested in four equal annual installments beginning November 17, 2001.
[F4]This option vested in four equal annual installments beginning November 29, 2002.
[F5]This option vested in four equal annual installments beginning January 20, 2004.

Documents

1 file