SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
HERMAN JOAN E

(Last) (First) (Middle)
120 MONUMENT CIRCLE

(Street)
INDIANAPOLIS IN 46204

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/30/2004
3. Issuer Name and Ticker or Trading Symbol
WELLPOINT INC [ WLP ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 114 I 401(k)
Common Stock 46,319 I The Herman-Rasiej Family Trust Account
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Deferred Comp Stock Units (1) (1) Common Stock 7,329 $0 D
Deferred Comp Stock Units (2) (2) Common Stock 2,568 $0 D
Deferred Comp Stock Units (3) (3) Common Stock 10,600 $0 D
Employee Stock Option (right to buy) (4) 06/04/2008 Common Stock 2,884 $29.28 D
Employee Stock Option (right to buy) (4) 06/04/2008 Common Stock 432 $38.39 D
Employee Stock Option (right to buy) (4) 06/04/2008 Common Stock 367 $34.81 D
Employee Stock Option (right to buy) (4) 06/03/2011 Common Stock 59,520 $34.92 D
Employee Stock Option (right to buy) (4) 06/04/2008 Common Stock 6,148 $34.92 D
Employee Stock Option (right to buy) (4) 01/31/2011 Common Stock 80,114 $38.9 D
Employee Stock Option (right to buy) (4) 06/04/2008 Common Stock 5 $39.72 D
Employee Stock Option (right to buy) (4) 02/11/2009 Common Stock 3,519 $39.86 D
Employee Stock Option (right to buy) (4) 06/04/2008 Common Stock 3,747 $43.47 D
Employee Stock Option (right to buy) (4) 06/04/2008 Common Stock 11,252 $47.54 D
Employee Stock Option (right to buy) (4) 06/03/2008 Common Stock 3,502 $49.04 D
Employee Stock Option (right to buy) (4) 02/10/2009 Common Stock 2,036 $49.04 D
Employee Stock Option (right to buy) (5) 02/06/2012 Common Stock 119,824 $51.21 D
Employee Stock Opton (right to buy) (4) 02/10/2010 Common Stock 1,822 $54.85 D
Employee Stock Option (right to buy) (4) 01/31/2011 Common Stock 17,711 $54.85 D
Employee Stock Option (right to buy) (6) 02/04/2013 Common Stock 68,200 $55.1 D
Employee Stock Option (right to buy) (4) 02/10/2010 Common Stock 9,036 $79.18 D
Employee Stock Option (right to buy) (4) 01/31/2011 Common Stock 6,749 $79.18 D
Employee Stock Option (right to buy) (4) 02/04/2013 Common Stock 36,586 $79.18 D
Employee Stock Option (right to buy) (7) 01/25/2014 Common Stock 79,360 $82.06 D
Employee Stock Option (right to buy) (4) 02/10/2009 Common Stock 8,467 $87.72 D
Employee Stock Option (right to buy) (4) 02/06/2012 Common Stock 10,157 $87.72 D
Employee Stock Option (right to buy) (4) 02/04/2013 Common Stock 17,118 $87.72 D
Employee Stock Option (right to buy) (4) 02/10/2010 Common Stock 3,244 $87.72 D
Employee Stock Option (right to buy) (4) 01/31/2011 Common Stock 1,138 $87.72 D
Explanation of Responses:
1. Deferred share right grant made in the Company's Comprehensive Executive Non-qualified Retirement Plan and awarded pursuant to the Company's 1999 Stock Incentive Plan. The deferred shares are fully vested.
2. Deferred share right grant made in the Company's Comprehensive Executive Non-qualified Retirement Plan and awarded pursuant to the Company's 1999 Stock Incentive Plan. The deferred shares will vest on March 15, 2005.
3. Deferred share right grant made in the Company's Comprehensive Executive Non-qualified Retirement Plan and awarded pursuant to the Company's 1999 Stock Incentive Plan. The deferred shares will vest in three equal annual installments beginning January 26, 2005, January 26, 2006 and January 26, 2007.
4. These shares are fully vested.
5. The options vested with respect to 97,504 shares and 22,320 options will vest on February 7, 2005.
6. The options will vest in three equal installments on February 5, 2005, August 5, 2005 and February 6, 2006.
7. The options are vested with respect to 13,226 shares and 66,134 options will vest in five equal installments on January 26, 2005, July 26, 2005, January 26, 2006, July 26, 2006 and January 26, 2007.
Remarks:
Nancy Purcell, Attorney-in-fact 12/02/2004
** 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 5 (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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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