-----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, ISbn+Um9pQlrFudJWl/fCCp5uZpZImoCzWQC4O3u75LHCLjW2d9pOR2qLz6jLEgf ERVZRhoZe38KDSMXyr/DZQ== 0000895813-98-000147.txt : 19980611 0000895813-98-000147.hdr.sgml : 19980611 ACCESSION NUMBER: 0000895813-98-000147 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980531 FILED AS OF DATE: 19980610 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN COUNTRY HOLDINGS INC CENTRAL INDEX KEY: 0000315411 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 060995978 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-22922 FILM NUMBER: 98645437 BUSINESS ADDRESS: STREET 1: 222 N LASALLE STREET STREET 2: C/O JOHN DE ELORZA CITY: CHICAGO STATE: IL ZIP: 60601-1105 BUSINESS PHONE: 3124562000 MAIL ADDRESS: STREET 1: 222 N LASALLE STREET CITY: CHICAGO STATE: IL ZIP: 60601-1105 FORMER COMPANY: FORMER CONFORMED NAME: WESTERN SYSTEMS CORP DATE OF NAME CHANGE: 19970326 FORMER COMPANY: FORMER CONFORMED NAME: WESTERN TRANSMEDIA CO INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: VIGILANCE SYSTEMS CORP DATE OF NAME CHANGE: 19920202 COMPANY DATA: COMPANY CONFORMED NAME: THOMAS WILMER J JR CENTRAL INDEX KEY: 0001004065 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 272 UNDER MOUNTAIN RD CITY: SALISBURY STATE: CT ZIP: 06068 MAIL ADDRESS: STREET 1: 272 UNDER MOUNTAIN RD CITY: SALISBURY STATE: CT ZIP: 06068 4 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person: Wilmer J. Thomas, Jr. 272 Undermountain Road Salisbury, Connecticut 06068 U.S.A. 2. Issuer Name and Ticker or Trading Symbol: American Country Holdings Inc. ACHI 3. IRS or Social Security Number of Reporting Person (Voluntary): ###-##-#### 4. Statement for Month/Year: May 1998 5. If Amendment, Date of Original (Month/Year): August 1997 6. Relationship of Reporting Person(s) to Issuer (Check all applicable): (x) Director (x) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 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. Amount of Securities 6. Owner- 7. Nature Beneficially ship Form: of 2. Transaction Owned at Direct (D) Indirect 1. Title of Date 3. Transaction 4. Securities Acquired End of Month or Indirect Beneficial Security (Month/ Code (A) or Disposed of (D) (Instr. (I) Ownership (Instr. 3) Day/Year) (Instr. 8) (Instr. 3, 4 & 5) 3 & 4) (Instr. 4) (Instr. 4) ----------- ------------- ------------- ---------------------- ------------ ---------- ---------- Code V Amount (A)or(D) Price Common Stock, 5/29/98 P 6000 A $1.88 8,006,343 D $.01 par value /TABLE
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) 9. Number 10. Owner- 5. Number of ship of Deriv- Deriva- Form of ative tive Deriva- 2. Conver- Securities Securities tive 1. Title sion or Acquired 6. Date 7. Title 8. Price Benefi- Security: 11. Nature of Exercise 3. Trans- (A) or Exercisable and of cially Direct of Deriva- Price of action 4. Trans- Disposed and Amount of Deriva- Owned at (D) or Indirect tive Deriva- Date action of (D) Expiration Underlying tive End of Indirect Beneficial Security tive (Month/ Code (Instr. 3, Date (Month/ Securities Security Month (I) Ownership (Instr. 3) Security Day/Year) (Instr. 8) 4 & 5) Day/Year) (Instr. 3 & 4) (Instr. 5) (Instr. 4) (Instr. 4) (Instr. 4) ---------- -------- --------- ---------- ---------- ------------- --------------- ---------- ---------- ---------- ---------- Code V (A) (D) Date Expira- Title Amount or Exer- tion Number of cisable Date Shares
Explanation of Responses: SIGNATURE OF REPORTING PERSON: /s/ Wilmer J. Thomas, Jr. ============================== -----END PRIVACY-ENHANCED MESSAGE-----