-----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, CjCIlJ8+BklmiRxvFgFCZ4AE57OAS78qBoODHjmkLXbyfT5BpN1alGArXGQ/vB4M +tJw4oG6VkoPO1q4XH48Zg== 0001317212-05-000082.txt : 20050523 0001317212-05-000082.hdr.sgml : 20050523 20050523183307 ACCESSION NUMBER: 0001317212-05-000082 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050519 FILED AS OF DATE: 20050523 DATE AS OF CHANGE: 20050523 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROSS LLOYD E CENTRAL INDEX KEY: 0001183991 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-31700 FILM NUMBER: 05852505 MAIL ADDRESS: STREET 1: PO BOX 2380 CITY: BIGFORK STATE: MT ZIP: 59911 4 1 edgardoc.xml PRIMARY DOCUMENT X0202 4 2005-05-19 0 0001027974 PACIFICARE HEALTH SYSTEMS INC /DE/ PHS 0001183991 ROSS LLOYD E 5995 PLAZA DRIVE CYPRESS CA 90630 1 0 0 0 Common Stock Units 2005-05-19 4 A 0 163 0 A Common Stock 163 5495 D Non-Qualified Stock Option (right to buy) 61.55 2005-05-19 4 A 0 4000 0 A 2005-05-19 2015-05-19 Common Stock 4000 4000 D The Common Stock Units were received in lieu of annual director fees as provided for under the PacifiCare Health Systems, Inc. 2005 Equity Incentive Plan (the "Plan"). Under the Plan, non-employee directors may elect to defer a portion of their annual retainer fees (on a pre-tax basis) into Common Stock Units held in an account maintained for the director under the Plan. The number of Common Stock Units a director receives is based on the closing price of PacifiCare's common stock on the day the annual retainer fee would have been paid but for the deferral. When a director terminates his or her service as a director, a distribution from the director's Common Stock Unit account under the Plan is made in a single payment of shares of PacifiCare common stock. Represents an annual formula grant of an Option (right to buy) under the PacifiCare Health Systems, Inc. 2005 Equity Incentive Plan (the "Plan") in a transaction exempt under Rule 16b-3. The Option is fully vested and exercisable on the date of grant (5/19/05); however, the underlying shares of PacifiCare common stock acquired upon exercise of the Option may not be sold or transferred within the first six months of the date of grant. Lloyd E Ross 2005-05-23 -----END PRIVACY-ENHANCED MESSAGE-----