-----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, PzrTYR6QAcVpjm1HwJgTlcKHQAmG7zxByCU32n5zCSGR6+KdH/BHYM/e6+1GNonr XzB3aJ39MbvOK/Mhhv6KfQ== 0001104659-03-021801.txt : 20030930 0001104659-03-021801.hdr.sgml : 20030930 20030930144754 ACCESSION NUMBER: 0001104659-03-021801 CONFORMED SUBMISSION TYPE: 15-12B PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20030930 EFFECTIVENESS DATE: 20030930 FILER: 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: 15-12B SEC ACT: 1934 Act SEC FILE NUMBER: 001-14177 FILM NUMBER: 03917328 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 15-12B 1 a03-3725_11512b.htm 15-12B

 

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM 15

 

CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934 OR SUSPENSION OF DUTY TO FILE REPORTS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.

 

Commission File Number:  1-14177

 

Cobalt Corporation

(Exact name of registrant as specified in its charter)

 

401 West Michigan Street
Milwaukee, Wisconsin  53203
(414) 226-6900

(Address, including zip code, and telephone number, including area
code, of registrant’s principal executive offices)

 

Common Stock, no par value

(Title of each class of securities covered by this Form)

 

None

(Titles of all other classes of securities for which a duty to file reports
under section 13(a) or 15(d) remains)

 

Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports:

 

Rule 12g-4(a)(1)(i)

 

ý

 

Rule 12h-3(b)(1)(i)

 

ý

Rule 12g-4(a)(1)(ii)

 

o

 

Rule 12h-3(b)(1)(ii)

 

o

Rule 12g-4(a)(2)(i)

 

o

 

Rule 12h-3(b)(2)(i)

 

o

Rule 12g-4(a)(2)(ii)

 

o

 

Rule 12h-3(b)(2)(ii)

 

o

 

 

 

 

Rule 15d-6

 

o

 

Approximate number of holders of record as of the certification or notice date: One*

*                                         Cobalt merged with and into Crossroads on September 24, 2003.  Pursuant to Rule 12g-4(b) under the Securities Exchange Act of 1934, this certification/notice is filed by Crossroads as successor issuer.

 

Pursuant to the requirements of the Securities Exchange Act of 1934, Crossroads Acquisition Corp. (“Crossroads”), a Delaware corporation, as successor in interest to Cobalt Corporation, a Wisconsin corporation (“Cobalt”), has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.

 

 

Date:  September 30, 2003

By:

/s/ ROBERT A. KELLY

 

 

 

Robert A. Kelly

 

 

Assistant Treasurer,
Assistant Secretary and
Vice President

 

Instruction:  This form is required by Rules 12g-4, 12h-3 and 15d-6 of the General Rules and Regulations under the Securities Exchange Act of 1934.  It may be signed by an officer of the registrant, by counsel or by any other duly authorized person.  The name and title of the person signing the form shall be typed or printed under the signature.

 

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