-----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, An0fWZOtf9zF/CbgSk1dw003tP0sxx6rJsgx0NzdI9IziyzOvCbdI1u/Bqh9eKio zWzVZFatkden8Z0LUU2F8w== 0001249013-04-000155.txt : 20041118 0001249013-04-000155.hdr.sgml : 20041118 20041118194420 ACCESSION NUMBER: 0001249013-04-000155 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041116 FILED AS OF DATE: 20041118 DATE AS OF CHANGE: 20041118 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HARTSHORN TERRY O CENTRAL INDEX KEY: 0001209518 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-31700 FILM NUMBER: 041156136 MAIL ADDRESS: STREET 1: 5995 PLAZA DR CITY: CYPRESS STATE: CA ZIP: 90630 ISSUER: 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: 1231 BUSINESS ADDRESS: STREET 1: 5995 PLAZA DRIVE CITY: CYPRESS STATE: CA ZIP: 90630-5028 BUSINESS PHONE: 714-952-1121 MAIL ADDRESS: STREET 1: 5995 PLAZA DRIVE CITY: CYPRESS STATE: CA ZIP: 90630-5028 FORMER COMPANY: FORMER CONFORMED NAME: N T HOLDINGS INC DATE OF NAME CHANGE: 19961204 4 1 edgardoc.xml PRIMARY DOCUMENT X0202 4 2004-11-16 0 0001027974 PACIFICARE HEALTH SYSTEMS INC /DE/ PHS 0001209518 HARTSHORN TERRY O 5995 PLAZA DRIVE CYPRESS CA 90630 1 0 0 0 Common Stock 2004-11-16 4 M 0 20000 32.781 A 94000 D Common Stock 2004-11-16 4 S 0 20000 46.2158 D 74000 D Common Stock 2004-11-16 4 M 0 10000 12.925 A 84000 D Common Stock 2004-11-16 4 S 0 10000 46.2158 D 74000 D Common Stock 2004-11-16 4 S 0 20000 46.1086 D 0 I by Partnership Common Stock 55464 I by Trust-Hart2 Non-Qualified Stock Option (right to buy) 12.925 2004-11-16 4 M 0 10000 0 D 2003-06-30 2012-07-01 Common Stock 10000 0 D Non-Qualified Stock Option (right to buy) 32.781 2004-11-16 4 M 0 20000 0 D 1996-02-14 2005-01-27 Common Stock 20000 0 D Exercise of stock option granted under the 1996 Stock Option Plan for Officers and Key Employees of PacifiCare Health Systems, Inc., as amended in a transaction exempt under Rule 16b-3. Exercise of stock option granted under the Amended and Restated 2000 Non-Employee Directors Stock Plan of PacifiCare Health Systems, Inc. in a transaction exempt under Rule 16b-3. The reported securities are held by the Hartshorn Family Limited Partnership of which the reporting person and his spouse hold a 1% general partnership interest. On November 16, 2004, the Hartshorn Family Limited Partnership sold 20,000 shares of PacifiCare common stock for an aggregate sale price of $922,172 (the "Transaction"). The reporting person did not receive any of the proceeds from the Transaction. The reporting person disclaims beneficial ownership of the PacifiCare common stock held by the Hartshorn Family Limited Partnership except to the extent of his pecuniary interest therein Terry O Hartshorn 2004-11-17 -----END PRIVACY-ENHANCED MESSAGE-----