-----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, QYtUzTNq0ti2s7h+ppSJJY8R8fsl4u1Ff7fKJkfuVWsKkW8V8W5Z7fg38FArRHUo HYV4ELb67Vyc7YRF0HezoQ== 0001014739-04-000043.txt : 20040616 0001014739-04-000043.hdr.sgml : 20040616 20040616092600 ACCESSION NUMBER: 0001014739-04-000043 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040615 FILED AS OF DATE: 20040616 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SALZMAN JACK CENTRAL INDEX KEY: 0001178779 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-28740 FILM NUMBER: 04865303 BUSINESS ADDRESS: STREET 1: C/O KINGS POINT PARTNERS STREET 2: 1010 FRANKLIN AVENUE STE 303 CITY: GARDEN CITY STATE: NY ZIP: 11530 BUSINESS PHONE: 5167465600 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MIM CORP CENTRAL INDEX KEY: 0001014739 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 050489664 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 CLEARBROOK RD CITY: ELMSFORD STATE: NY ZIP: 10523 BUSINESS PHONE: 914 460 1600 MAIL ADDRESS: STREET 1: 33 NORTH ROAD CITY: PEACE DALE STATE: RI ZIP: 02883 4 1 sal58.xml X0202 4 2004-06-15 0 0001014739 MIM CORP MIMS 0001178779 SALZMAN JACK 100 CLEARBROOK ROAD ELMSFORD NY 10523 1 0 0 0 Common Stock, $.0001 par value 125000 I By Shares Held By Ltd Partnership Common Stock, $.0001 par value 5000 I By Trading Account Common Stock, $.0001 par value 2000 I By Trust Option to Purchase Common Stock 7.6800 2004-06-15 4 A 0 5000 0 A 2005-05-25 2014-05-25 Common Stock, $.0001 par value 5000 5000 D Option to Purchase Common Stock 8.7700 2003-07-22 2012-07-22 Common Stock, $.0001 par value 20000 20000 D Option to Purchase Common Stock 6.5800 2004-06-05 2013-06-05 Common Stock, $.0001 par value 5000 5000 D Vests and becomes exercisable in three equal annual installments commencing on May 25, 2005. Vests and becomes exercisable in three equal annual installments commencing on the first anniversary of the date of grant. /s/ Salzman, Jack 2004-06-15 -----END PRIVACY-ENHANCED MESSAGE-----