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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/11/2012 |
3. Issuer Name and Ticker or Trading Symbol
HEALTH NET INC [ HNT ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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 | 39,341(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Stock Option (Right to Buy)(2) | 02/24/2006(5) | 02/24/2015 | Common Stock | 2,748(6) | $29.2 | D | |
Stock Option (Right to Buy)(3) | 03/02/2008(7) | 03/02/2016 | Common Stock | 2,500(8) | $49.06 | D | |
Stock Option (Right to Buy)(3) | 02/17/2007(9) | 03/06/2016 | Common Stock | 2,400(10) | $47.3 | D | |
Stock Option (Right to Buy)(4) | 02/09/2008(11) | 02/09/2017 | Common Stock | 12,000(12) | $52.08 | D | |
Stock Option (Right to Buy)(4) | 02/22/2013(13) | 02/22/2017 | Common Stock | 16,650 | $23.03 | D | |
Stock Option (Right to Buy)(4) | 02/18/2012(14) | 02/18/2018 | Common Stock | 14,000 | $30.73 | D |
Explanation of Responses: |
1. Includes 21,025 Restricted Stock Units ("RSUs") granted to the Reporting Person under the Issuer's 2006 Long-Term Incentive Plan, as amended (the "2006 Plan"), which RSUs vest and become non-forfeitable under the circumstances described in the applicable Restricted Stock Unit Agreements entered into between the Issuer and the Reporting Person. Also includes 11,235 performance shares granted to the Reporting Person under the Issuer's 2006 Plan. The performance measures attributed to the performance shares have been met and the grants become non-forfeitable under the circumstances described in the applicable performance share award agreements entered into between the Issuer and the Reporting Person. Also includes 633 shares in which the Reporting Person has a beneficial interest under the profit-sharing component of the Issuer's 401(k) Savings Plan. |
2. Stock Option granted to the Reporting Person under the Issuer's 2002 Stock Option Plan, as amended (the "2002 Plan"), in a transaction exempt under Rule 16b-3 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"). |
3. Stock Option granted to the Reporting Person under the Issuer's 2005 Long-Term Incentive Plan, as amended (the "2005 Plan"), in a transaction exempt under Rule 16b-3 of the Exchange Act. |
4. Stock Option granted to the Reporting Person under the Issuer's 2006 Plan in a transaction exempt under Rule 16b-3 of the Exchange Act. |
5. The stock option became exercisable in 25% increments on each of the first, second, third and fourth anniversaries of the February 24, 2005 grant date. |
6. Represents vested and unexercised options from the 2,748 share option grant made to the Reporting Person on February 24, 2005. |
7. The stock option became exercisable with respect to 50% of the options on March 2, 2008. The remaining 50% of the options became exercisable on March 2, 2010. |
8. Represents vested and unexercised options from the 2,500 share option grant made to the Reporting Person on March 2, 2006. |
9. The stock option became exercisable with respect to 50% of the options on February 17, 2007. The remaining 50% of the options became exercisable on February 17, 2008. |
10. Represents vested and unexercised options from the 2,400 share option grant made to the Reporting Person on March 6, 2006. |
11. The stock option became exercisable in 25% increments on each of the first, second, third and fourth anniversaries of the February 9, 2007 grant date. |
12. Represents vested and unexercised options from the 12,000 share option grant made to the Reporting Person on February 9, 2007. |
13. The stock option becomes exercisable with respect to 100% of the options on February 22, 2013. |
14. The stock option becomes exercisable in 33-1/3% increments on each of the first, second and third anniversaries of the February 18, 2011 grant date. |
/s/ Juanell Hefner | 01/24/2012 | |
** 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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |