-----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, GQ8s/Yf9FpAKLCy4B0a8Kw6dnSrLC2sCq9GAudAFjrsgcMeXSR8Udq+vY351gffw u/Gmtrl0SqF8LzMXVwHoUQ== 0000049071-97-000036.txt : 19970222 0000049071-97-000036.hdr.sgml : 19970222 ACCESSION NUMBER: 0000049071-97-000036 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19961231 FILED AS OF DATE: 19970213 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: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-05975 FILM NUMBER: 97530942 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: JONES DAVID A CENTRAL INDEX KEY: 0000905631 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] DIRECTOR STATE OF INCORPORATION: KY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O HUMANA INC STREET 2: 500 WEST MAIN ST CITY: LOUISVILLE STATE: KY ZIP: 40202 BUSINESS PHONE: 5025803778 MAIL ADDRESS: STREET 1: 500 WEST MAIN ST CITY: LOUISVILLE STATE: KY ZIP: 40202 5 1 FORM 5 - DECEMBER 31, 1996 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). ( ) Form 3 Holdings Reported ( ) Form 4 Transactions Reported 1. Name and Address of Reporting Person Jones, David A. 500 W. Main St. Louisville, KY 40202 USA 2. Issuer Name and Ticker or Trading Symbol Humana Inc. HUM 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year December 31, 1996 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Chairman of the Board and Chief Executive Officer 7. Individual or Joint/Group Reporting (Check Applicable Line) (X) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person
___________________________________________________________________________________________________________________________________ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | |Transaction| or Disposed of (D) | Securities |ect | Beneficial Ownership | |Date |Code| | Beneficially |(D)or | | | | | | A/| | Owned at |Indir | | | | | Amount | D | Price | End of Year |ect(I)| | ___________________________________________________________________________________________________________________________________| Common(1) | | | | | |4,314,206 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| Common(1) | | | | | |600,912 |I |Wife | - -----------------------------------------------------------------------------------------------------------------------------------| Common(1) | | | | | |1,424,481 |I |Trust(2) | - -----------------------------------------------------------------------------------------------------------------------------------| Common(1) |(3) |A |297.1 |A |(3) |270,151.7 |I |HRSP(3) | - -----------------------------------------------------------------------------------------------------------------------------------| Common(1) | | | | | |2,676,951 |I |FLP(4) | - -----------------------------------------------------------------------------------------------------------------------------------| Common(1) | | | | | |216,815 |I |Trust(5) | - -----------------------------------------------------------------------------------------------------------------------------------| Common(1) | | | | | |0 |I |Trust(6)(7) | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | |300,000 |I |FLP-96(8) | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Con |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of| Security |version |Transaction rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | |or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise Pr | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership | |ice of | | | posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva | | | |Date |Expir| | |ficially |Ind| | |tive | | | | A/|Exer-|ation| Title and Number | |Owned at |ire| | |Secu | | | | D |cisa-|Date | of Shares | |End of |ct | | |rity | | | Amount | |ble | | | |Year |(I)| | ___________________________________________________________________________________________________________________________________| Option(9) |19.3125 | | | | |11/14|11/14|Common(1) |300,000| |300,000 |D | | | | | | | |/97 |/06 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Phantom Stock Units(3) |1-for-1 |(3) |A |38,004.7 |A |(3) |(3) |Common(1) |38,004.| |38,004.7 |I |SERP(3) | | | | | | | | | |7 | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
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 of certain specified events occur, to acquire 1/100th of a share of Series A Participating Preferred Stock at a price of $145 per fractional share. (2) Shares held in 1991 Trust of which I am settlor and trustee with investment and voting power. The Trust is for my benefit and the benefit of family members. (3) On-going acquisitions of shares from January 1, 1996 to December 31, 1996 at prices ranging from $16.326 to $27.875 pursuant to the Humana Retirement and Savings Plan ("HRSP") and the related phantom acquisitions under the Company Excess Benefit Plans ("SERP"), exempt under 16a-3(f)(1)(i)(B); being listed to report any shares acquired prior to the SEC rule changes in 8/96. (4) Shares held by a 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. I disclaim beneficial ownership of Company stock held by the FLP except to the extent of my pecuniary interest. (5) Shares held in 1996 Trust of which I am settlor and trustee with investment and voting power. The trust is for my benefit and the benefit of family members. (6) Shares held in 1995 Trust of which Betty A. Jones, my wife, is settlor and Trustee with investment and voting power. The Trust is for her benefit and the benefit of family members. (7) Shares held in 1995 Trust of which I am settlor and Trustee with investment and voting power. The trust is for my benefit and the benefit of family members. (8) Shares held by 1996 Family Limited Partnership ("FLP-96") of which my wife and I are General Partners, and together with a Family Charitable Foundation are Limited Partners. I disclaim beneficial owernship of Company stock held by the FLP-96 except to the extent of my pecuniary interest. (9) Right to Buy pursuant the Company's 1996 Stock Incentive Plan for Employees. -----END PRIVACY-ENHANCED MESSAGE-----