SEC FORM 4

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

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

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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^*

MOORE TIMOTHY J

(Last)

(First)

(Middle)

C/O AMERICAN MEDICAL SECURITY GROUP INC

3100 AMS BLVD

(Street)

GREEN BAY

54313

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
AMERICAN MEDICAL SECURITY GROUP INC [ AMZ ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
Sr VP, General Counsel, Sec.

3. Date of Earliest Transaction (Month/Day/Year)
12/13/2004

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. 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
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	12/13/2004		D		4,700	D	$32.75	0	D
Common Stock	12/13/2004		D		8,895.5 ^{( 1 )}	D	$32.75	0	I	By 401(k) plan

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Employee Stock Option (right to buy)	$17.19	12/13/2004		D			11,616	^{( 2 )}	03/02/2009	Common Stock	11,616	$15.56	0	D
Employee Stock Option (right to buy)	$10.25	12/13/2004		D			35,000	^{( 3 )}	09/27/2010	Common Stock	35,000	$22.5	0	D
Employee Stock Option (right to buy)	$12	12/13/2004		D			25,000	^{( 4 )}	09/27/2010	Common Stock	25,000	$20.75	0	D
Employee Stock Option (right to buy)	$12.25	12/13/2004		D			4,770	11/17/1998	11/16/2010	Common Stock	4,770	$20.5	0	D
Employee Stock Option (right to buy)	$5.8125	12/13/2004		D			16,475	^{( 5 )}	11/16/2011	Common Stock	16,475	$26.9375	0	D
Employee Stock Option (right to buy)	$5.1875	12/13/2004		D			5,000	^{( 6 )}	11/16/2012	Common Stock	5,000	$27.5625	0	D
Employee Stock Option (right to buy)	$10.2	12/13/2004		D			25,000	^{( 7 )}	11/28/2013	Common Stock	25,000	$22.55	0	D
Employee Stock Option (right to buy)	$14.41	12/13/2004		D			21,000	^{( 8 )}	01/19/2015	Common Stock	21,000	$18.34	0	D

Explanation of Responses:

1. The reporting person acquired 139.9 shares of AMZ common stock under the issuer's 401(k) plan since November 24, 2003. Such acquisitions, which were not "discretionary transaction" as defined in Rule 16b-3(b) are exempt from Section 16b by virtue of Rule 16b-3(c) and are exempt from the reporting requirements of Section 16(a) by virtue of Rule 16a-3(f)(l)(i)(B).

2. This option became fully vested September 28, 1998.

3. This option vested in four equal annual installments beginning September 28, 1999.

4. This option vested in four equal annual installments beginning September 28, 1999.

5. This option vested in four equal annual installments beginning November 17, 2000.

6. This option vested in four equal annual installments beginning November 17, 2001.

7. This option vested in four equal annual installments beginning November 29, 2002.

8. This option vested in four equal annual installments beginning January 20, 2004.

	Timothy J. Moore	12/15/2004
	** Signature of Reporting Person	Date
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