-----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, LAc3BuRe8IP2l/zQDodOpaOE8rKgRNPBnQz6t8J7sD7v8/lYzFCufgK4hWop93QG 3QBLX0d1BLVB5yvjqh0rMw== 0000936392-01-500340.txt : 20020412 0000936392-01-500340.hdr.sgml : 20020412 ACCESSION NUMBER: 0000936392-01-500340 CONFORMED SUBMISSION TYPE: 8-A12G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20011204 FILER: 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: 8-A12G SEC ACT: 1934 Act SEC FILE NUMBER: 000-21949 FILM NUMBER: 1806199 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 8-A12G 1 a77684e8-a12g.txt FORM 8-A12G SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 ------------ FORM 8-A FOR REGISTRATION OF CERTAIN CLASSES OF SECURITIES PURSUANT TO SECTION 12(b) OR 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934 PACIFICARE HEALTH SYSTEMS, INC. ------------------------------------------------------ (Exact Name of Registrant as Specified in its Charter) Delaware 95-4591529 ---------------------------------------- ------------------- (State of Incorporation or Organization) (I.R.S. Employer Identification no.) 3120 Lake Center Drive, Santa Ana, CA 92704 ---------------------------------------- ------------------- (Address of principal executive offices) (Zip code) If this form relates to the registration of a class of securities pursuant to Section 12(b) of the Exchange Act and is effective upon filing pursuant to General Instruction A.(c), check the following box. [ ] If this form relates to the registration of a class of securities pursuant to Section 12(g) of the Exchange Act and is effective pursuant to General Instruction A.(d), check the following box. [X] Securities Act registration statement number to which this form relates: Not Applicable --------------- (if applicable) Securities to be registered pursuant to Section 12(b) of the Act: Title of Each Class to Name of Each Exchange on Which be so Registered Each Class is to be Registered None ---------------------- ------------------------------ Securities to be registered pursuant to Section 12(g) of the Act: Common stock, par value $.01 per share, including related rights to purchase Series A junior participating preferred stock - ------------------------------------------------------------------------- (Title of class) 1. ITEM 1. DESCRIPTION OF REGISTRANT'S SECURITIES TO BE REGISTERED. A description of the common stock to be registered hereunder is contained in the section entitled "Description of Securities" included in the Registrant's Form S-8 Registration Statement, No. 333-72168, filed with the Securities and Exchange Commission (the "Commission") on October 24, 2001 and incorporated by reference herein. A description of the rights to purchase Series A junior participating preferred stock to be registered hereunder is contained in the Registrant's Form 8-K and the exhibits thereto filed with the Commission on November 19, 1999 and incorporated by reference herein. This Form 8-A amends the Form 8-B filed by N-T Holdings, Inc., the Registrant's former name, with the Commission on January 9, 1997, under which the Registrant registered Class A and Class B common stock. In 1999, the Registrant, with stockholder approval, amended and restated its certificate of incorporation to combine and reclassify its Class A and Class B common stock into a single class of common stock, which is the common stock being registered hereunder. ITEM 2. EXHIBITS. EXHIBIT NO. DESCRIPTION - ----------- ----------- 3.1 Amended and Restated Certificate of Incorporation (incorporated by reference to Exhibit 99.1 to the Registrant's Registration Statement on Form S-3 (File No. 333-83069) filed on July 16, 1999) 3.2 Bylaws (incorporated by reference to Exhibit 99.2 to the Registrant's Registration Statement on Form S-3 (File No. 333-83069) filed on July 16, 1999) 4.1 Specimen Common Stock certificate (incorporated by reference to Exhibit 4.02 to the Registrant's Form 10-K for the year ended December 31, 1999) 4.2 Certificate of Designation of Series A Junior Participating Preferred Stock (incorporated by reference to Exhibit 4.1 to the Registrant's Form 8-K filed on November 19, 1999) 4.3 Rights Agreement, dated as of November 19, 1999, between the Registrant and ChaseMellon Shareholder Services, L.L.C. (incorporated by reference to Exhibit 99.2 to the Registrant's Form 8-K filed on November 19, 1999) 2. SIGNATURE Pursuant to the requirements of Section 12 of the Securities Exchange Act of 1934, the Registrant has caused this registration statement to be signed on its behalf by the undersigned, thereunto duly authorized. PACIFICARE HEALTH SYSTEMS, INC. Date: December 3, 2001 By: /s/ SUSAN L. BERKEL -------------------------------- Susan L. Berkel Senior Vice President, Finance and Corporate Controller 3. -----END PRIVACY-ENHANCED MESSAGE-----