-----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, A0V3lDf2pbZjY9V+BePWP3eSGMq3iQVwErDwbE8Kjol+9NyzOnHmzXYg/EAYnKna rS5bS7Nv2kte4YtwaYLTRA== 0000904454-06-000180.txt : 20060208 0000904454-06-000180.hdr.sgml : 20060208 20060208173021 ACCESSION NUMBER: 0000904454-06-000180 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20060209 FILED AS OF DATE: 20060208 DATE AS OF CHANGE: 20060208 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WELSH PATRICK J CENTRAL INDEX KEY: 0001212985 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51767 FILM NUMBER: 06590086 BUSINESS ADDRESS: BUSINESS PHONE: 2128939500 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMCOMP INC /FL CENTRAL INDEX KEY: 0001009667 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 650636842 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 701 U S HIGHWAY ONE STREET 2: SUITE 200 CITY: NORTH PALM BEACH STATE: FL ZIP: 33408 BUSINESS PHONE: 5618407171 MAIL ADDRESS: STREET 1: 701 US HIGHWAY ONE STREET 2: SUITE 200 CITY: NORTH PALM BEACH STATE: FL ZIP: 33408 3 1 edgar.xml PRIMARY DOCUMENT X0202 3 2006-02-09 0 0001009667 AMCOMP INC /FL AMCP 0001212985 WELSH PATRICK J C/O WELSH, CARSON, ANDERSON AND STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 Common Stock 1008328 I By Welsh, Carson, Anderson & Stowe VII, L.P. Common Stock 10871 D Common Stock 18119 I By WCAS Healthcare Partners, L.P. Series A Convertible Preferred Stock Common Stock 2332518 I By Welsh, Carson, Anderson & Stowe VII, L.P. Series A Convertible Preferred Stock Common Stock 25148 D Series A Convertible Preferred Stock Common Stock 41914 I By WCAS Healthcare Partners, L.P. The Reporting Person is a general partner of the respective sole general partners of Welsh, Carson, Anderson & Stowe VII, L.P. and WCAS Healthcare Partners, L.P. Pursuant to Instruction (5)(b)(iv) of Form 3, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by each such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein, and/or that are not actually distributed to him. Reflects a 1 for 2.2904 reverse split of the Common Stock effected immediately prior to the effectiveness of the Issuer's initial public offering. The Series A Convertible Preferred Stock will automatically convert into Common Stock immediately prior to the closing of the Issuer's initial public offering, for no additional consideration. Jonathan M. Rather, Attorney-in-Fact 2006-02-08 -----END PRIVACY-ENHANCED MESSAGE-----