-----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, Nl3q/iVcz3Hc4NnPsz8xnLM21V5Pap3VhwKinx0jg5hrgapxZER7RiuLXYXWQLJ2 g5WGHNMWwZtXOQ340Sgq/Q== 0001144204-05-027926.txt : 20050902 0001144204-05-027926.hdr.sgml : 20050902 20050902124642 ACCESSION NUMBER: 0001144204-05-027926 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20041201 FILED AS OF DATE: 20050902 DATE AS OF CHANGE: 20050902 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HEALTHAXIS INC CENTRAL INDEX KEY: 0000768892 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING SERVICES [7371] IRS NUMBER: 232214195 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2500 DEKALB PIKE CITY: NORRISTOWN STATE: PA ZIP: 19401 BUSINESS PHONE: 6102792500 MAIL ADDRESS: STREET 1: 2500 DEKALB PIKE STREET 2: PO BOX 511 CITY: NORRISTOWN STATE: PA ZIP: 19404-0511 FORMER COMPANY: FORMER CONFORMED NAME: PROVIDENT AMERICAN CORP DATE OF NAME CHANGE: 19920703 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LEHMAN BROTHERS INC// CENTRAL INDEX KEY: 0000728586 STANDARD INDUSTRIAL CLASSIFICATION: SECURITY BROKERS, DEALERS & FLOTATION COMPANIES [6211] STATE OF INCORPORATION: DE FISCAL YEAR END: 1130 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13591 FILM NUMBER: 051066946 BUSINESS ADDRESS: STREET 1: LEHMAN BROTHERS INC. STREET 2: 3 WORLD FINANCIAL CENTER CITY: NEW YORK STATE: NY ZIP: 10285 BUSINESS PHONE: 2125267000 MAIL ADDRESS: STREET 1: LEHMAN BROTHERS INC. STREET 2: 3 WORLD FINANCIAL CENTER CITY: NEW YORK STATE: NY ZIP: 10285 FORMER NAME: FORMER CONFORMED NAME: SHEARSON LEHMAN BROTHERS INC DATE OF NAME CHANGE: 19920703 FORMER NAME: FORMER CONFORMED NAME: SHEARSON LEHMAN HUTTON INC /DE/ DATE OF NAME CHANGE: 19900828 FORMER NAME: FORMER CONFORMED NAME: SHEARSON LEHMAN BROTHERS INC /DE/ DATE OF NAME CHANGE: 19880323 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LB I GROUP INC CENTRAL INDEX KEY: 0001045004 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13591 FILM NUMBER: 051066947 BUSINESS ADDRESS: STREET 1: 3 WORLD FINANCIAL CENTER STREET 2: 200 VASEY ST CITY: NEW YORK STATE: NY ZIP: 10285 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LEHMAN BROTHERS HOLDINGS INC CENTRAL INDEX KEY: 0000806085 STANDARD INDUSTRIAL CLASSIFICATION: SECURITY BROKERS, DEALERS & FLOTATION COMPANIES [6211] STATE OF INCORPORATION: DE FISCAL YEAR END: 1130 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13591 FILM NUMBER: 051066948 BUSINESS ADDRESS: STREET 1: LEHMAN BROTHERS STREET 2: 745 SEVENTH AVENUE CITY: NEW YORK STATE: NY ZIP: 10019 BUSINESS PHONE: 2125267000 MAIL ADDRESS: STREET 1: LEHMAN BROTHERS STREET 2: 745 SEVENTH AVENUE CITY: NEW YORK STATE: NY ZIP: 10019 FORMER NAME: FORMER CONFORMED NAME: SHEARSON LEHMAN HUTTON HOLDINGS INC DATE OF NAME CHANGE: 19901017 4 1 v025142_ex.xml X0202 4 2004-12-01 0 0000768892 HEALTHAXIS INC HAXS 0000806085 LEHMAN BROTHERS HOLDINGS INC 745 SEVENTH AVENUE NEW YORK NY 10019 0 0 1 1 See Remark 1 below 0001045004 LB I GROUP INC 745 SEVENTH AVENUE NEW YORK NY 10019 0 0 1 1 See Remark 1 below 0000728586 LEHMAN BROTHERS INC// 745 SEVENTH AVENUE NEW YORK NY 10019 0 0 1 1 See Remark 1 below Common Stock, $0.10 par value 2004-12-01 4 P 0 2050 2.7856 A 664999 I See Remark (1) below Common Stock, $0.10 par value 2004-12-01 4 P 0 50 2.77 A 665049 I See Remark (1) below Common Stock, $0.10 par value 2004-12-01 4 P 0 100 2.7590 A 665149 I See Remark (1) below Common Stock, $0.10 par value 2004-12-01 4 P 0 100 2.76 A 665249 I See Remark (1) below Common Stock, $0.10 par value 2004-12-01 4 P 0 800 2.80 A 666049 I See Remark (1) below Common Stock, $0.10 par value 2004-12-01 4 P 0 1000 2.78 A 667049 I See Remark (1) below Common Stock, $0.10 par value 2004-12-01 4 S 0 2050 2.7856 D 664999 I See Remark (1) below Common Stock, $0.10 par value 2005-01-04 4 P 0 200 2.10 A 665199 I See Remark (1) below Common Stock, $0.10 par value 2005-01-04 4 S 0 200 2.15 D 664999 I See Remark (1) below Common Stock, $0.10 par value 2005-01-13 4 S 0 1000 2.8550 D 663999 I See Remark (1) below Common Stock, $0.10 par value 2005-01-13 4 P 0 1000 3.10 A 664999 I See Remark (1) below Common Stock, $0.10 par value 2005-01-20 4 P 0 200 2.20 A 665199 I See Remark (1) below Common Stock, $0.10 par value 2005-01-20 4 S 0 200 2.2950 D 664999 I See Remark (1) below Common Stock, $0.10 par value 2005-02-24 4 P 0 1000 2.5192 A 665999 I See Remark (1) below Common Stock, $0.10 par value 2005-02-25 4 P 0 3000 2.6364 A 668999 I See Remark (1) below Common Stock, $0.10 par value 2005-02-25 4 P 0 2000 2.6950 A 670999 I See Remark (1) below Common Stock, $0.10 par value 2005-02-25 4 S 0 3000 2.6364 D 667999 I See Remark (1) below See Exhibit 99.1 (1) This form is a joint filing with the following affiliates of the Reporting Person, Lehman Brothers Holdings Inc. ("Holdings"): Lehman Brothers Inc., a Delaware corporation ("LBI") and LB I Group, a Delaware corporation. Holdings owns 100% of LBI, which owns 100% of LB I Group. Holdings, LBI and LB I Group may be deemed to be 10% owners of the Issuer. This report is being filed by Holdings. Other Joint Filers: LBI, 745 Seventh Avenue, New York, New York 10019; and LB I Group, 745 Seventh Avenue, New York, New York 10019. The signatory below is signing on behalf of all Joint Filers. /s/ Barrett S. DiPaolo 2005-09-01 EX-99.1 2 v025142_ex99-1.txt Exhibit 99.1 Explanation of Responses: (1) LB I Group Inc. ("LB I Group") holds (i) shares of Series A Preferred Stock (the "Series A Shares") convertible into 740,401 shares of common stock, $0.10 par value (the "Common Shares") of Healthaxis, Inc. (the "Company"), (ii) warrants exercisable for an additional 387,117 Common Shares and, (iii) 667,999 Common Shares. However, the Series A Shares and the warrants are subject to an issuance limitation prohibiting LB I Group from converting or exercising those securities to the extent that such conversion or exercise would result in beneficial ownership by LB I Group and its affiliates of more than 4.99% of the then outstanding Common Shares. Thus, for the purposes of Reg. Section 240.13d-3, the Reporting Person is deemed to beneficially own 667,999 Common Shares as of February 25, 2005. The Reporting Person has disgorged to the Company all profits that may be deemed to have been realized from transactions in the equity securities of the Company, within the meaning of Section 16(b) of the Securities Exchange Act of 1934, as amended. -----END PRIVACY-ENHANCED MESSAGE-----