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Registration No. 333-00134
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As filed with the Securities and Exchange Commission on August 22, 1997
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
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AMENDMENT NO.3 TO FORM S-4
REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933
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MIDWEST MEDICAL INSURANCE HOLDING COMPANY
(Exact name of registrant as specified in its Charter)
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State or other jurisdiction of incorporation or organization: Minnesota
Primary Standard Industrial Classification Code Number: 6749
IRS Employer Identification Number: 41-1625287
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6600 France Avenue South, Suite 245
Minneapolis, MN 55435, (612) 922-5445
(Address, including zip code, and telephone number,
including area code, of registrant's principal executive offices)
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David P. Bounk, President
Midwest Medical Insurance Holding Company
6600 France Avenue South, Suite 245
Minneapolis, MN 55435, (612) 922-5445
(Name, address, including zip code, and telephone number,
including area code, of agent for service)
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COPIES TO:
Charles A. Geer, Esq. Ross C. Formell, Esq.
General Counsel for Registrant Best & Flanagan, Professional
4440 IDS Center Limited Liability Partnership
80 South Eighth Street 4000 First Bank Place
Minneapolis, MN 55402 601 Second Avenue South
Minneapolis, MN 55402
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Approximate date of commencement of proposed sale of the securities to
the public: April 26, 1996.
If the securities being registered on this form are being offered in
connection with the formation of a holding company and there is compliance
with General Instruction G, check the following box.
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CALCULATION OF REGISTRATION FEE
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Title of Each Proposed Proposed
Class of Maximum Maximum
Securities Amount Offering Aggregate Amount of
to be to be Price Offering Registration
Registered Registered Per Unit Price Fee
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Class A 5,447 shares(1) $927.27(1)(2) $6,490,890(1)(2) $2,238.24
Common Stock
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(1) Previously estimated solely for the purpose of calculating the
registration fee.
(2) Based upon book values of interests to be cancelled in the merger and
securities of the registrant to be issued as of December 31, 1995.
The registrant hereby amends this Registration Statement on such date or
dates as may be necessary to delay its effective date until the registrant
shall file a further amendment which specifically states that this
Registration Statement shall thereafter become effective in accordance with
Section 8(a) of the Securities Act of 1933 or until the Registration
Statement shall become effective on such date as the Commission, acting
pursuant to Section 8(a), may determine.
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SIGNATURES
Pursuant to the requirements of the Securities Act, the registrant has
duly caused this Amendment No. 3 to the Registration Statement to be signed
on its behalf by the undersigned, thereunto duly authorized, in the City of
Minneapolis, State of Minnesota, on August 22, 1997.
MIDWEST MEDICAL INSURANCE HOLDING
COMPANY
By: /s/ David P. Bounk
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David P. Bounk, President and
Chief Executive Officer
Pursuant to the requirements of the Securities Act of 1933, this
Amendment No. 3 to the Registration Statement has been signed by the
following persons in the capacities indicated on August 22, 1997.
Signature Capacity
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/s/ David P. Bounk
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David P. Bounk Principal Executive Officer and
Director
/s/ Merlin R. Bretzman
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Merlin R. Bretzman Principal Financial Officer and
Principal Accounting Officer
*
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George V. Tangen, M.D. Director, Chairman of the Board
*
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James R. Bishop, M.D. Director
*
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E. Duane Engstrom, M.D. Director
*
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William Eversman, M.D. Director
*
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John R. Balfanz, M.D. Director
*
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Roger L. Frerichs, M.D. Director
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*
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G. Richard Geier, Jr. M.D. Director
*
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Eldon E. Huston Director
*
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Wayne F. Leebaw, M.D. Director
*
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Stephen A. McCue, M.D. Director
*
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Anton S. Nesse, M.D. Director
*
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Eugene C. Ott, M.D. Director
*
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Erick Reeber, M.D. Director
*
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Norman Rinderknecht, M.D. Director
*
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Paul S. Sanders, M.D. Director
*
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Richard D. Schmidt, M.D. Director
*
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Mark B. Siegel, M.D. Director
*
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Andrew J.K. Smith, M.D. Director
*
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G. David Spoelhof, M.D. Director
*
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Bruce R. Trimble, M.D. Director
*
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Daniel Youngblade, M.D. Director
* By: /s/ David P. Bounk
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David P. Bounk pursuant to
power of attorney
The above persons signing as directors are a majority of the directors of the
registrant.
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