-----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, E1+zKPs6T5jLXslr9saCIYHpytmEt5gfxZv5CkYm8Fx5edZbF1gKuRQ+ldq0L2su aWh942s2huXDrkk1tYBePQ== 0000897069-03-000023.txt : 20030106 0000897069-03-000023.hdr.sgml : 20030106 20030106155430 ACCESSION NUMBER: 0000897069-03-000023 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20030102 FILED AS OF DATE: 20030106 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: BABLITCH STEPHEN E CENTRAL INDEX KEY: 0001195083 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: COBALT CORP STREET 2: 401 WEST MICHIGAN ST CITY: MILWAUKEE STATE: WI ZIP: 53203 BUSINESS PHONE: 4142265000 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: COBALT CORP CENTRAL INDEX KEY: 0001062780 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 391931212 STATE OF INCORPORATION: WI FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14177 FILM NUMBER: 03505115 BUSINESS ADDRESS: STREET 1: 401 WEST MICHIGAN STREET CITY: MILWAUKEE STATE: WI ZIP: 53203-2896 BUSINESS PHONE: 4142266900 MAIL ADDRESS: STREET 1: 401 WEST MICHIGAN STREET CITY: MILWAUKEE STATE: WI ZIP: 52030-2896 FORMER COMPANY: FORMER CONFORMED NAME: UNITED WISCONSIN SERVICES INC DATE OF NAME CHANGE: 19981112 4 1 irm83.txt FORM 4 ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response ....... 0.5 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 [_] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ________________________________________________________________________________ 1. Name and Address of Reporting Person* BABLITCH, STEPHEN E. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 401 WEST MICHIGAN STREET - -------------------------------------------------------------------------------- (Street) MILWAUKEE, WI 53203 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol COBALT CORPORATION (NYSE: CBZ) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Day/Year January 2, 2003 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ================================================================================ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [_] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) Chief Executive Officer and Chairman of the Board ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [_] Form filed by more than one Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. 6. 2A. 4. Amount of Owner- Deemed Securities Acquired (A) or Securities ship 2. Execution 3. Disposed of (D) Beneficially Form: 7. Transaction Date, if Transaction (Instr. 3, 4 and 5) Owned Follow- Direct Nature of Date any Code ------------------------------- ing Reported (D) or Indirect 1. (Month/ (Month/ (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Day/ Day/ ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) Year) Year) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 01/02/03 A 31,000 A 31,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 4,000 D Joint with wife - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 2,611.17* I By 401(k) Plan - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ * Shares of common stock held in the reporting person's 401(k) plan as of March 31, 2002. ==================================================================================================================================== Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Persons who respond to the collection of information contained in this form are not required to respond (Over) unless the form displays a currently valid OMB control number. SEC 1474 (9-02)
FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ====================================================================================================================================
10. 9. Owner- Number ship of Deriv- Form 2. ative of Conver- 5. 7. Secur- Deriv- 11. sion Number of Title and Amount ities ative Nature or 3A. Derivative 6. of Underlying 8. Benefi- Secur- of Exer- Deemed 4. Securities Date Securities Price cially ity: In- cise 3. Execu- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Owned Direct direct Price Trans- tion action or Disposed Expiration Date ---------------- Deriv- Following (D) or Bene- 1. of action Date, Code of(D) (Month/Day/Year) Amount ative Reported In- ficial Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity action(s) (I) ship Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr (Instr (Instr (Instr (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy) $12.85 10/01/97(1) 9/30/08 * 22,087 22,087 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy) $11.60 01/02/98(1) 01/02/09 * 33,130 33,130 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy) $11.72 01/02/98(1) 01/02/09 * 44,174 44,174 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy) $7.1875 09/28/99(1) 09/27/10 * 35,000 35,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy) $8.50 01/26/00(1) 01/25/11 * 41,000 41,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy) $4.3125 01/03/01(1) 01/02/12 * 121,200 121,200 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy)(2) $8.20 03/25/03(1) 03/25/14 * 160,000 160,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy)(2) $19.99 05/29/03(1) 5/29/14 * 90,000 90,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (right to buy)(2) $14.10 01/02/03 A 129,000 01/02/04(1) 12/31/15 * 129,000 129,000 D ==================================================================================================================================== Explanation of Responses: * Common Stock (1) The option vests in four equal annual installments beginning the first anniversary after the date of grant. (2) Grant to reporting person of option to buy shares of common stock under the Cobalt Corporation Equity Incentive Plan. STEPHEN E. BABLITCH ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Peter C. Underwood 01/03/03 ------------------------------------- ---------- See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ** Signature of Reporting Person Date By Peter C. Underwood, Attorney-In-Fact Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2
EX-99 3 irm83a.txt POWER OF ATTORNEY POWER OF ATTORNEY Know all by these presents, that the undersigned hereby constitutes and appoints Peter Underwood of Foley & Lardner, signing singly, the undersigned's true and lawful attorney-in-fact to: (1) execute for and on behalf of the undersigned, in the undersigned's capacity as an officer, director and/or more than 5% shareholder of Cobalt Corporation (the "Company"), any and all forms, applications and other documents as may be necessary or advisable for the undersigned to file under the Securities Exchange Act of 1934 and the rules thereunder (the "Exchange Act"), including, without limitation, Forms 3, 4 and 5 and Schedules 13D and 13G in accordance with Section 16(a) and Section 13(d), respectively of the Exchange Act (collectively, "Documents"); (2) do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Documents and timely file such Documents with the United States Securities and Exchange Commission and any stock exchange or similar authority; and (3) take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in his/her discretion. The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with the Exchange Act. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Documents with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 3rd day of January, 2003. /s/ Stephen E. Bablitch ----------------------------- Signature Stephen E. Bablitch ----------------------------- Print Name -----END PRIVACY-ENHANCED MESSAGE-----