-----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, GwMsMXFVrQGN7/pJ6YxrcGYivVfkSYPBH39ISGxAg7IohZafCoVF/p7+gSw80Dpw NfLzvE5e3HL5VQL4BeMBgA== 0001181431-04-047927.txt : 20041018 0001181431-04-047927.hdr.sgml : 20041018 20041018165953 ACCESSION NUMBER: 0001181431-04-047927 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041015 FILED AS OF DATE: 20041018 DATE AS OF CHANGE: 20041018 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FREMONT MICHIGAN INSURACORP INC CENTRAL INDEX KEY: 0001271245 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 421609947 BUSINESS ADDRESS: STREET 1: 933 EAST MAIN ST CITY: FREMONT STATE: MI ZIP: 49412 9751 BUSINESS PHONE: 231 924 0300 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HALL WILLIAM CENTRAL INDEX KEY: 0001299678 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-50926 FILM NUMBER: 041083654 BUSINESS ADDRESS: BUSINESS PHONE: 231-924-0300 MAIL ADDRESS: STREET 1: 933 E. MAIN STREET CITY: FREMONT STATE: MI ZIP: 49412 4 1 rrd55035.xml HALL FORM 4 - 10/15/2004 X0202 4 2004-10-15 0 0001271245 FREMONT MICHIGAN INSURACORP INC NONE 0001299678 HALL WILLIAM 933 EAST MAIN FREMONT MI 49412 0 1 0 0 1ST VICE PRESIDENT & COO Common Stock 2004-10-15 4 P 0 10103 10 A 10103 D Stock Option <Right to Buy> 10 2004-10-15 4 A 0 500 10 A 2005-10-15 2014-10-15 Common Stock 500 500 D Stock Option <Right to Buy> 10 2004-10-15 4 A 0 500 10 A 2006-10-15 2014-10-15 Common Stock 500 1000 D Stock Option <Right to Buy> 10 2004-10-15 4 A 0 500 10 A 2007-10-15 2014-10-15 Common Stock 500 1500 D Stock Option <Right to Buy> 10 2004-10-15 4 A 0 500 10 A 2008-10-15 2014-10-15 Common Stock 500 2000 D Stock Option <Right to Buy> 10 2004-10-15 4 A 0 500 10 A 2009-10-15 2014-10-15 Common Stock 500 2500 D /s/ Marvin Deur, Attorney-in-Fact 2004-10-18 -----END PRIVACY-ENHANCED MESSAGE-----