-----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, MNTEcxCeTEkeAIhZVdiEeQpaVFGXcrHHpuHebOcBzfnU3BXJWwySfbDlj2wz3YdA f99XF0xxDW0ePZ5JXr4akQ== 0001317212-05-000064.txt : 20050512 0001317212-05-000064.hdr.sgml : 20050512 20050512134526 ACCESSION NUMBER: 0001317212-05-000064 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050510 FILED AS OF DATE: 20050512 DATE AS OF CHANGE: 20050512 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ho Samuel W CENTRAL INDEX KEY: 0001319287 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-31700 FILM NUMBER: 05823576 BUSINESS ADDRESS: BUSINESS PHONE: (714) 226-3500 MAIL ADDRESS: STREET 1: 5995 PLAZA DRIVE 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 2005-05-10 0 0001027974 PACIFICARE HEALTH SYSTEMS INC /DE/ PHS 0001319287 Ho Samuel W 5995 PLAZA DRIVE CYPRESS CA 90630 0 1 0 0 EVP, Chief Medical Officer Common Stock 2005-05-10 4 M 0 7500 13.21 A 15236.448 D Common Stock 2005-05-10 4 S 0 7500 62.6 D 7736.448 D Common Stock 1543 I By 401(k) plan Common Stock 4706 I by Trust Non-Qualified Stock Option (right to buy) 13.21 2005-05-10 4 M 0 7500 0 D 2004-05-04 2012-05-09 Common Stock 7500 42500 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. These shares are held by the Samuel W Ho Living Trust dated July 23, 2004 of which the reporting person is the trustee and the beneficiary. On April 4, 2005 reporting person transferred 1,274 shares from his direct ownership account into his living trust account resulting in a change in form of ownership. Ho, Samuel W 2005-05-11 -----END PRIVACY-ENHANCED MESSAGE-----