-----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, KumN9stmGI7PWc8gTzqfFwidQqloEvs/Xl0O4ILaWxX+P6ByTTnGRyGjolYEyLJA 4+tvHFNNGjPPbBgXu8abcw== 0000950117-98-001091.txt : 19980519 0000950117-98-001091.hdr.sgml : 19980519 ACCESSION NUMBER: 0000950117-98-001091 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980508 FILED AS OF DATE: 19980518 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MAXICARE HEALTH PLANS INC CENTRAL INDEX KEY: 0000722573 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 953615709 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-12024 FILM NUMBER: 98627406 BUSINESS ADDRESS: STREET 1: 1149 S BROADWAY ST STREET 2: SUITE 910 CITY: LOS ANGELES STATE: CA ZIP: 90015 BUSINESS PHONE: 2137652000 COMPANY DATA: COMPANY CONFORMED NAME: DAVIES ROBERT M CENTRAL INDEX KEY: 0001017999 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: TECHNOLOGY SERVICE GROUP INC STREET 2: 20 MANSELL COURT EAST CITY: ROSWELL STATE: GA ZIP: 30076 BUSINESS PHONE: 7705870208 3 1 ROBERT M. DAVIES FORM 3
U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 - ------------- FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES - ------------- Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or Trading Symbol Statement (Month/Day/Year) DAVIES, ROBERT M. 05/8/98 MAXICARE (MAXI) - ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS Identification Number 5. Relationship of Reporting 6. If Amendment, of Reporting Person Person to Issuer Date of Original if an Entity (Month/Day/Year) N/A Director N/A The Menai Group, LLC, 100 Stamford Pl., 6th fl. - ----------------------------------------------------------------------------------------------------------------------------------- (Street) 7. Individual or Group/Joint Filing X Form filed by One --- Reporting Person Form filed by --- More Than One Stamford CT 06902 Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect Beneficial Beneficially Owned Direct (D) or Ownership Indirect (I) - ----------------------------------------------------------------------------------------------------------------------------------- None - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
Form 3 (continued) Table II - Derivative Securities Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Date Exercisable 3. Title and Amount of 4. Conversion 5. Ownership 6. Nature of and Expiration Date Securities Underlying or Exercise Form: Direct (D) Indirect Derivative Security Price of or Indirect (I) Beneficial Derivative Ownership Security - --------------------------------------------------------------------------------------------- ---------------------- None - ----------------------------------------------------------------------------------------------------------------------------------- Explanation of Responses: /s/ Robert M. Davies 5/18/98 ---------------------------------- ------- Signature of Reporting Person Date
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