-----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, EvIBfb7uQZvsgrzVtubuQP5T4Y6eFAhH8olQGn2iDgz1OJAcgszb4mRG0T8NIoH6 UB4WW7fRtNeTnkRpfaM9zQ== 0001317212-05-000111.txt : 20051220 0001317212-05-000111.hdr.sgml : 20051220 20051220203728 ACCESSION NUMBER: 0001317212-05-000111 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20051219 FILED AS OF DATE: 20051220 DATE AS OF CHANGE: 20051220 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KOSECOFF JACQUELINE B CENTRAL INDEX KEY: 0001209524 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-31700 FILM NUMBER: 051276807 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 2005-12-19 0 0001027974 PACIFICARE HEALTH SYSTEMS INC /DE/ PHS 0001209524 KOSECOFF JACQUELINE B 5995 PLAZA DRIVE CYPRESS CA 90630 0 1 0 0 EVP, Pharmaceutical Services Common Stock Units 2005-12-19 4 A 0 3822 0 A Common Stock 3822 20987 D Represents the deferral of a portion of the reporting person's annual bonus into Common Stock Units under the PacifiCare Health Systems, Inc. Third Amended and Restated Stock Unit Deferred Compensation Plan. Upon distribution, the reporting person receives shares of PacifiCare Common Stock equal to the number of vested Common Stock Units held. The Common Stock Units will be distributed on the earlier of (i) the date, after 12/31/07, specified in an election made by the reporting person or (ii) the reporting person's termination of employment, death, disability or change of control of the Company. The Common Stock Units will be distributed in a lump sum or equal installments over 3 to 5 years as specified in an election made by the reporting person, except for distributions upon change of control which will be distributed in a lump sum. By: Michael E. Jansen For: Jacqueline B. Kosecoff 2005-12-20 EX-24 2 kosecoffpowerofattorney.txt EDGAR SUPPORTING DOCUMENT POWER OF ATTORNEY I, Jacqueline B. Kosecoff, do hereby constitute and appoint Joseph S. Konowiecki, Michael E. Jansen and Ellen K. Erickson, or each one of them separately, as my true and lawful attorneys and agents, to do any and all lawful acts and things in my name and on my behalf, and to execute any and all instruments, forms or filings in my name and on my behalf, which said attorneys and agents, or each one of them separately, may deem necessary or advisable in order for me to comply with the disclosure requirements of Section 16(a) of the Securities Exchange Act of 1934, and any related rules, regulations, and requirements of the Securities and Exchange Commission; and do hereby ratify and confirm all that said attorneys and agents, or each one of them separately, shall do or cause to be done by virtue hereof. Date: May 17, 2004 Jacqueline B. Kosecoff -----END PRIVACY-ENHANCED MESSAGE-----