-----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, UOfla/eZ4kQpfzO3m7AR7bktXAr+9Susm3at/KhScxOkI86QkkulZWT3XRTA3GXu sXOlasdG7S2+nOUus6BrXw== 0001005477-04-003419.txt : 20040923 0001005477-04-003419.hdr.sgml : 20040923 20040923172651 ACCESSION NUMBER: 0001005477-04-003419 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040913 FILED AS OF DATE: 20040923 DATE AS OF CHANGE: 20040923 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Aholt Robert Joseph JR CENTRAL INDEX KEY: 0001304011 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10909 FILM NUMBER: 041043539 BUSINESS ADDRESS: BUSINESS PHONE: 310 748-1734 MAIL ADDRESS: STREET 1: 20128 CAVERN COURT CITY: SAUGUS STATE: CA ZIP: 91390 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PHASE III MEDICAL INC/DE CENTRAL INDEX KEY: 0000320017 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE CARRIERS, NEC [6399] IRS NUMBER: 222343568 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 330 SOUTH SERVICE ROAD STREET 2: SUITE 120 CITY: MELVILLE STATE: NY ZIP: 11747 BUSINESS PHONE: 6315744955 MAIL ADDRESS: STREET 1: 330 SOUTH SERVICE ROAD STREET 2: SUITE 120 CITY: MELVILLE STATE: NY ZIP: 11747 FORMER COMPANY: FORMER CONFORMED NAME: CORNICHE GROUP INC /DE DATE OF NAME CHANGE: 19951117 FORMER COMPANY: FORMER CONFORMED NAME: FIDELITY MEDICAL INC DATE OF NAME CHANGE: 19951025 FORMER COMPANY: FORMER CONFORMED NAME: FIDELITY MEDICAL SERVICES INC DATE OF NAME CHANGE: 19830825 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Aholt Jr Family Trust CENTRAL INDEX KEY: 0001304164 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10909 FILM NUMBER: 041043538 BUSINESS ADDRESS: STREET 1: 20128 CAVERN COURT CITY: SAUGUS STATE: CA ZIP: 91390 BUSINESS PHONE: 310 748-1734 MAIL ADDRESS: STREET 1: 20128 CAVERN COURT CITY: SAUGUS STATE: CA ZIP: 91390 3 1 edgar123.xml FORM 3