-----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, WU8aEp0q5hbvoPJE2LckCT4c/50XyXc+e0Yr776Zpgi8wTnFzqYU3KSEEapUxRUC x8FEzT4hTnY/SHi1z8zB4g== 0000049071-03-000054.txt : 20030617 0000049071-03-000054.hdr.sgml : 20030617 20030617105347 ACCESSION NUMBER: 0000049071-03-000054 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030616 FILED AS OF DATE: 20030617 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HUMANA INC CENTRAL INDEX KEY: 0000049071 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 610647538 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 500 W MAIN ST CITY: LOUISVILLE STATE: KY ZIP: 40202 BUSINESS PHONE: 5025801000 FORMER COMPANY: FORMER CONFORMED NAME: EXTENDICARE INC DATE OF NAME CHANGE: 19740404 FORMER COMPANY: FORMER CONFORMED NAME: HERITAGE HOUSE OF AMERICA INC DATE OF NAME CHANGE: 19671129 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: JONES DAVID A SR/KY CENTRAL INDEX KEY: 0001070038 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-05975 FILM NUMBER: 03746754 BUSINESS ADDRESS: STREET 1: C/O HUMANA INC STREET 2: 500 W MAIN ST CITY: LOUISVILLE STATE: KY ZIP: 40202 BUSINESS PHONE: 5025801000 MAIL ADDRESS: STREET 1: C/O HUMANA INC STREET 2: 500 W MAIN ST 27TH FL CITY: LOUISVILLE STATE: KY ZIP: 40202 4 1 edgar.xml PRIMARY DOCUMENT X0101 42003-06-16 0000049071 HUMANA INC HUM 0001070038 JONES DAVID A SR/KY 1000Humana Common2003-06-164S02000015.50D1345032D< footnoteId id="F4"/>Each share of Common Stock contains a Right adopted on March 5, 1987, pursuant to the Company Rights Agreement, as amended and restated on February 14, 1996, and amended as of May 27, 1998 and March 1, 1999, which entitles holders of the Company's Common Stock, in the event certain specified events occur, to acquire 1/100 of a share of Series A Participating Preferred Stock at a price of $145 per fractional share.Reporting person indirectly owns the following shares: 610,140 shares held by Family Limited Partnership ("FLP") of which my wife and I are General Partners and Trusts established by each of us are Limited Partners, together with a Family Charitable Foundation; 152,808 shares held by 96 A/J Family Limited Partnership of which my wife and I are General Partners, and together with a Family Charitable Foundation are Limited Partners; 30,000 sha res held by my wife; 375,406 shares held by Jones Investments, Ltd., a partnership of which DBJ, LLC is the General Partner. My wife and I are the members of DBJ, LLC; 4,495,067 shares held by David A. Jones Revocable Trust of which I am Settlor and Trustee; 1,385 shares held by Betty A. Jones Revocable Trust of which she is Settlor and Trustee; 1,000,000 shares held by DBJ Investments, Ltd., a limited partnership of which I am a limited partner and DBJ, LLC is the General Partner. My wife and I are the members of DBJ, LLC.Reporting person has a right to buy 280,000 derivative securities (options) acquired between 1/2/98 and 1/2/03 at the exercise prices between $7.875 and $18.7813, of which 108,334 are currently exercisable.On 3/22/01, Jones entered into a forward sale agreement ("FAGT") relating to up to 451,700 shs of Com Stk. In connection with the FAGT, between 3/14-22/01, the counterparty sold 451,700 shs of Com Stk into the public mkt in accordance w/paragraphs (f) and (g) of Rule 144 under the Sec. Act of 1933, as amd, at an avg price of $11.32 per shr. The FAGT provides that 3 bus. days after 3/22/04 Jones will deliver a # of shs of Com Stk (or, at the election of Jones, the cash eqv of such shs) based on: (a) if the closing price of the Com Stk on 3/22/04 ("Fin Price") is < $11.32 p/shr, Jones will deliver 451,700 shs; (b) if the Fin Price is = to or > $11.32 per shr ("Fl Price") but < or = to $13.92 p/shr (the "Cap Price"), Jones will deliver a # of shs = to Fl Price/Final price x 451,700; and (c) if the Fin Price is > than the Cap Price, Jones will del. a # of shs = to Fl Price + (Fin. Price-Cap Price)/Fin Price x 451,700. In consideration, Jones has rcv'd $4,381,490.David A. Jones2003-06-16 -----END PRIVACY-ENHANCED MESSAGE-----