SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
BRUNNER DANIEL S

(Last) (First) (Middle)
3200 HIGHLAND AVENUE

(Street)
DOWNERS GROVE IL 60515

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FIRST HEALTH GROUP CORP [ FHCC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
01/28/2005
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 01/28/2005 D 212,404 D (1) 0 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Option to Purchase $28.02 01/28/2005 D 16,000 05/15/2002 05/15/2012 Common Stock 16,000 $1.25(2) 0 D
Option to Purchase $25.22 01/28/2005 D 16,000 05/13/2003 05/13/2013 Common Stock 16,000 $1.25(2) 0 D
Option to Purchase $15.23 01/28/2005 D 16,000 05/13/2004 05/13/2014 Common Stock 16,000 $1.25(2) 0 D
Option to Purchase $27.81 01/28/2005 D 16,000 (3) 09/25/2008 Common Stock 16,000 $1.25(2) 0 D
Explanation of Responses:
1. Disposed of pursuant to the merger agreement, dated October 13, 2004, by and among Coventry Health Care, Inc. ("Coventry"), Coventry Merger Sub Inc., and the issuer, in exchange for (a) 0.1791 shares of Coventry common stock having a market value of $54.75 per share on the effective date of the merger and (b) $9.375 in cash, per share.
2. On January 28, 2005, these options were cancelled pursuant to the issuer's option tender offer in exchange for payment for each underlying share of common stock equal to the greater of: (a) the amount by which $18.75 exceeded the exercise price of the option, if any, or (b) $1.25.
3. This option provided for vesting in two installments beginning on August 31, 2001.
/s/ Thomas M. Mastri, Attorney in Fact for Daniel S. Brunner 02/01/2005
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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