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
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*
SCOTT GREGORY W

(Last) (First) (Middle)
5995 PLAZA DRIVE

(Street)
CYPRESS CA 90630

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
PACIFICARE HEALTH SYSTEMS INC /DE/ [ PHS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP, Chief Financial Officer
3. Date of Earliest Transaction (Month/Day/Year)
11/15/2004
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)
Code V Amount (A) or (D) Price
Common Stock 11/15/2004 M 1,500 A $8.656 43,736.476 D
Common Stock 11/15/2004 S(1) 1,500 D $45.55 42,236.476 D
Common Stock 11/15/2004 M 500 A $8.656 42,736.476 D
Common Stock 11/15/2004 S(1) 500 D $45.56 42,236.476 D
Common Stock 11/15/2004 M 2,300 A $8.656 44,536.476 D
Common Stock 11/15/2004 S(1) 2,300 D $45.59 42,236.476 D
Common Stock 11/15/2004 M 5,000 A $8.656 47,236.476 D
Common Stock 11/15/2004 S(1) 5,000 D $45.64 42,236.476 D
Common Stock 11/15/2004 M 1,500 A $8.656 43,736.476 D
Common Stock 11/15/2004 S(1) 1,500 D $45.65 42,236.476 D
Common Stock 11/15/2004 M 600 A $8.656 42,836.476 D
Common Stock 11/15/2004 S(1) 600 D $45.71 42,236.476 D
Common Stock 11/15/2004 M 500 A $8.656 42,736.476 D
Common Stock 11/15/2004 S(1) 500 D $45.72 42,236.476 D
Common Stock 11/15/2004 M 500 A $8.656 42,736.476 D
Common Stock 11/15/2004 S(1) 500 D $45.75 42,236.476 D
Common Stock 11/15/2004 M 500 A $8.656 42,736.476 D
Common Stock 11/15/2004 S(1) 500 D $45.81 42,236.476 D
Common Stock 11/15/2004 M 1,000 A $8.656 43,236.476 D
Common Stock 11/15/2004 S(1) 1,000 D $45.86 42,236.476 D
Common Stock 11/15/2004 M 4,100 A $8.656 46,336.476 D
Common Stock 11/15/2004 S(1) 4,100 D $45.87 42,236.476 D
Common Stock 11/15/2004 M 600 A $8.656 42,836.476 D
Common Stock 11/15/2004 S(1) 600 D $45.88 42,236.476 D
Common Stock 11/15/2004 M 2,700 A $8.656 44,936.476 D
Common Stock 11/15/2004 S(1) 2,700 D $45.9 42,236.476 D
Common Stock 11/15/2004 M 3,700 A $8.656 45,936.476 D
Common Stock 11/15/2004 S(1) 3,700 D $45.91 42,236.476 D
Common Stock 2,730 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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 1,500 01/22/2003 01/22/2011 Common Stock 1,500 $0 173,500 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 500 01/22/2003 01/22/2011 Common Stock 500 $0 173,000 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 2,300 01/22/2003 01/22/2011 Common Stock 2,300 $0 170,700 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 5,000 01/22/2003 01/22/2011 Common Stock 5,000 $0 165,700 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 1,500 01/22/2003 01/22/2011 Common Stock 1,500 $0 164,200 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 600 01/22/2003 01/22/2011 Common Stock 600 $0 163,600 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 500 01/22/2003 01/22/2011 Common Stock 500 $0 163,100 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 500 01/22/2003 01/22/2011 Common Stock 500 $0 162,600 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 500 01/22/2003 01/22/2011 Common Stock 500 $0 162,100 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 1,000 01/22/2003 01/22/2011 Common Stock 1,000 $0 161,100 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 4,100 01/22/2003 01/22/2011 Common Stock 4,100 $0 157,000 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 600 01/22/2003 01/22/2011 Common Stock 600 $0 156,400 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 2,700 01/22/2004 01/22/2011 Common Stock 2,700 $0 153,700 D
Non-Qualified Stock Option (right to buy) $8.656 11/15/2004 M(1) 3,700 01/22/2003 01/22/2011 Common Stock 3,700 $0 150,000 D
Explanation of Responses:
1. Exercise of stock option granted under the 2000 Employee Plan of PacifiCare Health Systems, Inc. in a transaction exempt under Rule 16b-3. The stock option exercise and sale of shares acquired upon exercise were made pursuant to the reporting person's 10b5-1 plan.
By: Ellen K Erickson For: Gregory W Scott 11/17/2004
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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