-----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, Pe5VJTLIQtxvl7I8TBXjc8lVUxyPi82gfzjPSK1rpDjRERzDRWhDiW2S9XY7J8Z6 FrK4KDRu5fRwpQ1EwF6MQA== 0000049071-97-000010.txt : 19970110 0000049071-97-000010.hdr.sgml : 19970110 ACCESSION NUMBER: 0000049071-97-000010 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970109 SROS: NYSE SUBJECT COMPANY: 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 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-05975 FILM NUMBER: 97503057 BUSINESS ADDRESS: STREET 1: 500 W MAIN ST CITY: LOUISVILLE STATE: KY ZIP: 40202 BUSINESS PHONE: 5025803708 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 COMPANY DATA: COMPANY CONFORMED NAME: ZACHARIAS TOD J CENTRAL INDEX KEY: 0001030271 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER IRS NUMBER: 392641322 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 1100 EMPLOYERS BLVD CITY: GREEN BAY STATE: WI ZIP: 54344 BUSINESS PHONE: 4143361000 MAIL ADDRESS: STREET 1: 500 WEST MAIN STREET CITY: LOUISVILLE STATE: KY ZIP: 40202 3 1 FORM 3 - DECEMBER 30, 1996 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 1. Name and Address of Reporting Person Zacharias, Tod J. Employers Health Insurance Company 1100 Employers Boulevard Green Bay,, WI 54344 USA 2. Date of Event Requiring Statement (Month/Day/Year) December 30, 1996 3. IRS or Social Security Number of Reporting Person (Voluntary) ###-##-#### 4. Issuer Name and Ticker or Trading Symbol Humana Inc. HUM 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Vice President-Employers Health Ins. Co. 6. If Amendment, Date of Original (Month/Day/Year) 7. Individual or Joint/Group Filing (Check Applicable Line) (X) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person
___________________________________________________________________________________________________________________________________ Table I -- Non-Derivative Securities Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1. Title of Security |2. Amount of |3. Ownership |4. Nature of Indirect | | Securities | Form: | Beneficial Ownership | | Beneficially | Direct(D) or | | | Owned | Indirect(I) | | ___________________________________________________________________________________________________________________________________| Common (1) |1,000 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Common (1) |2,767.5734 |I |HRSP(2) | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Date Exer- |3.Title and Amount | |4. Conver-|5. Owner- |6. Nature of Indirect | Security | cisable and | of Underlying | |sion or |ship | Beneficial Ownership | | Expiration | Securities | |exercise |Form of | | | Date(Month/ |-----------------------|---------|price of |Deriv- | | | Day/Year) | |Amount |deri- |ative | | | Date | Expira- | |or |vative |Security: | | | Exer- | tion | Title |Number of|Security |Direct(D) or | | | cisable | Date | |Shares | |Indirect(I) | | ___________________________________________________________________________________________________________________________________| Option(4) |11/16/97 |11/16/05 |Common(1) |6,250 |22.625 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Option(4) |11/16/98 |11/16/05 |Common(1) |6,250 |22.625 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Option(4) |11/16/99 |11/16/05 |Common(1) |6,250 |22.625 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Option(4) |11/16/00 |11/16/05 |Common(1) |6,250 |22.625 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Option(5) |08/12/97 |08/12/06 |Common(1) |20,000 |19.1875 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Option(5) |08/12/98 |08/12/06 |Common(1) |20,000 |19.1875 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Option(5) |08/12/99 |08/12/06 |Common(1) |20,000 |19.1875 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Phanton Stock Units(3) |(3) |(3) |Common(1) |0 |1-for-1 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: (1) Each share of Common Stock contains a Right adopted on March 5, 1987, as amended and restated on February 14, 1996, pursuant to the Company Rights Agreement, 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. (2) Shares held for my benefit as of November 30, 1996, under the Humana Retirement and Savings Plan ("HRSP") exempt under Rule 16b-3(c). (3) Phantom stock units held for my benefit as of November 30,1996, under the Humana Excess Plans exempt under Rule 16b-3(d). (4) Right to buy pursuant to the Company's 1989 Stock Option Plan for Employees (5) Right to buy pursuant to the Company's 1996 Stock Incentive Plan -----END PRIVACY-ENHANCED MESSAGE-----