-----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, CzJunO0agDA3FTHc4sfJpmbyFWxWNFZJn73pNr51U+iRdUpCuNrcFPlc3j0oLTUD uR5V6ASN3zm/P/xDEADJ2w== 0000892569-03-000017.txt : 20030103 0000892569-03-000017.hdr.sgml : 20030103 20030103144459 ACCESSION NUMBER: 0000892569-03-000017 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030103 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: BOWLUS BRADFORD A CENTRAL INDEX KEY: 0001209505 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 MAIL ADDRESS: STREET 1: 5995 PLAZA DR CITY: CYPRESS STATE: CA ZIP: 90630 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PACIFICARE HEALTH SYSTEMS INC /DE/ CENTRAL INDEX KEY: 0001027974 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 954591529 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21949 FILM NUMBER: 03502725 BUSINESS ADDRESS: STREET 1: 3120 LAKE CENTER DRIVE CITY: SANTA ANA STATE: CA ZIP: 92704 BUSINESS PHONE: 7148255200 MAIL ADDRESS: STREET 1: 3120 LAKE CENTER DRIVE CITY: SANTA ANA STATE: CA ZIP: 92704 FORMER COMPANY: FORMER CONFORMED NAME: N T HOLDINGS INC DATE OF NAME CHANGE: 19961204 4 1 a86819e4.htm FORM 4 e4
 

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

FORM 4

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

o 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*		 2. Issuer Name and Ticker or Trading
Symbol		 3. I.R.S. Identification Number of Reporting
Person, if an entity (Voluntary)
  Bowlus, Bradford A
(Last) (First) (Middle)		   PacifiCare Health Systems, Inc.
  
     
  5995 Plaza Drive
(Street)		 4. Statement for Month/Day/Year 5. If Amendment, Date of Original (Month/Day/Year)
    12/31/2002
  
     
    6. Relationship of Reporting Person(s)
to Issuer (Check All Applicable)		 7. Individual or Joint/Group Filing
(Check Applicable Line)
  Cypress, CA 90630
(City)        (State)        (Zip)		   o  Director o  10% Owner   x Form Filed by One Reporting Person
    x  Officer (give title below)   o Form Filed by More than One Reporting Person
    o  Other (specify below)  
     
     
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).

 

                                               
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 Sec-
urities Beneficially
Owned Following
Reported Trans-
action(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   07/31/02     J V     193.873(1)   A   $20.1200         D  
  Common Stock   12/31/02     M     11,000.000   A   $16.3750         D  
  Common Stock   12/31/02     S     11,000.000   D   $28.4399     6,531.873     D  
  Common Stock                   333.000     I   By 401(k) plan
                         
                         
                         
                         
                         
                         
                         

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Page 2

 
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)
                      Code V   (A) (D)
  Common Stock Units                            
  Non-Qualified Stock Option (right to buy)     $16.3750     12/31/02       M       11,000.000
  Non-Qualified Stock Option (right to buy)     $18.3800                      
  Non-Qualified Stock Option (right to buy)     $45.3125                      
  Non-Qualified Stock Option (right to buy)     $53.8750                      
  Non-Qualified Stock Option (right to buy)     $66.7500                      
  Non-Qualified Stock Option (right to buy)     $67.0000                      
  Non-Qualified Stock Option (right to buy)     $68.8750                      
  Non-Qualified Stock Option (right to buy)     $68.8750                      
  Non-Qualified Stock Option (right to buy)     $69.5000                      

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Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)		 7. Title and Amount
of Underlying Securities
(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 of
Derivative Security:
Direct (D) or
Indirect (I)
(Instr. 4)		 11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
  Date
Exercisable		 Expiration
Date		   Title Amount or
Number of
Shares		                        
        Common Stock 8,407.000             8,407.000     D    
  (2) 01/02/11   Common Stock 11,000.000             139,000.000     D    
    01/24/12   Common Stock 175,000.000             175,000.000     D    
    11/05/09   Common Stock 100,000.000             100,000.000     D    
    08/24/10   Common Stock 100,000.000             100,000.000     D    
    12/21/04   Common Stock 2,000.000             2,000.000     D    
    10/02/07   Common Stock 15,000.000             15,000.000     D    
    02/15/07   Common Stock 10,000.000             10,000.000     D    
    08/29/07   Common Stock 20,000.000             20,000.000     D    
    10/11/95   Common Stock 6,500.000             6,500.000     D    

See continuation page(s) for footnotes

**   Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
 
Note:   File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

     Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.

Page 4

 
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)
                      Code V   (A) (D)
  Non-Qualified Stock Option (right to buy)     $71.5938            
  Non-Qualified Stock Option (right to buy)     $72.8750            
  Non-Qualified Stock Option (right to buy)     $92.5000            
  Non-Qualified Stock Option (right to buy)     $114.0000     10/06/02     V
(3)		 V   75,000.000
               
               
               
               
               
               

Page 5

 
Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
  (e.g., puts, calls, warrants, options, convertible securities)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)		 7. Title and Amount
of Underlying Securities
(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 of
Derivative Security:
Direct (D) or
Indirect (I)
(Instr. 4)		 11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
  Date
Exercisable		 Expiration
Date		   Title Amount or
Number of
Shares		                        
    04/22/09   Common Stock 40,000.000           40,000.000     D  
  03/27/08   Common Stock 10,000.000           10,000.000     D  
    10/07/07   Common Stock 75,000.000           75,000.000     D  
  10/06/02   Common Stock 75,000.000           0.000     D  
                   
                   
                   
                   
                   
                   

Explanation of Responses:

(1) Includes 193 shares acquired under the PacifiCare Health Systems stock purchase plan in July 2002.

(2) Granted under the 1996 Stock Option Plan for Officers and Key Employees of PacifiCare Health Systems, Inc., as amended, which is a Rule 16b-3 plan. The options become vested in four equal annual installments beginning on the first anniversary January 1, 2002.

(3) Options expired on 10/6/02.

/s/ Gregory W. Scott   1-2-03
**Signature of Reporting Person		  
Date

By: Gregory W Scott
For: Bradford A Bowlus

**   Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
 
Note:   File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

     Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.

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