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*
Haytaian Peter D

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

(Street)
INDIANAPOLIS IN 46260

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/01/2014
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 & Pres., Govt. Bus. Div.
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 52,709(1) D
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
Employee Stock Option (Right to Buy) (2) 09/28/2019 Common Stock 3,870 $60.15 D
Employee Stock Option (Right to Buy) (3) 03/01/2020 Common Stock 7,523 $61.88 D
Employee Stock Option (Right to Buy) (4) 03/03/2021 Common Stock 11,409 $89.44 D
Employee Stock Option (Right to Buy) (5) 05/01/2021 Common Stock 10,127 $100.77 D
Explanation of Responses:
1. Includes 43,082 restricted shares, which vest on various dates between December 1, 2014 and May 1, 2017.
2. The option, representing a right to purchase a total of 3,870 shares, became exercisable in two equal annual installments of 967 shares each and two equal annual installments of 968 shares each beginning on December 31, 2012, which was the three-month anniversary of the date on which the option was granted.
3. The option, representing a right to purchase a total of 7,523 shares, became exercisable in one installment of 1,253 shares and five equal semi-annual installments of 1,254 shares each beginning on September 1, 2013, which was the six-month anniversary of the date on which the option was granted.
4. The option, representing a right to purchase a total of 11,409 shares, is exercisable in three equal semi-annual installments of 1,901 shares each and three equal semi-annual installments of 1,902 shares each beginning on September 3, 2014, which is the six-month anniversary of the date on which the option was granted.
5. The option, representing a right to purchase a total of 10,127 shares, is exercisable in one installment of 1,687 shares and five equal semi-annual installments of 1,688 shares each beginning on November 1, 2014, which is the six-month anniversary of the date on which the option was granted.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Kathleen S. Kiefer, Attorney in fact 06/04/2014
** 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.