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) 05/13/2005 |
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 | 6,725(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) | 12/04/1999(3) | 12/04/2008 | Common Stock | 25,000 | $12.9375 | D | |
Stock Option (Right to Buy)(2) | 02/14/2001(4) | 02/14/2010 | Common Stock | 8,334(5) | $9 | D | |
Stock Option (Right to Buy)(6) | 02/09/2002(7) | 02/09/2011 | Common Stock | 25,000 | $23.02 | D | |
Stock Option (Right to Buy)(2) | 10/18/2002(8) | 10/18/2011 | Common Stock | 10,000 | $20.52 | D | |
Stock Option (Right to Buy)(2) | 08/12/2003(9) | 08/12/2012 | Common Stock | 35,000 | $22.64 | D | |
Stock Option (Right to Buy)(2) | 02/20/2004(10) | 02/20/2013 | Common Stock | 40,000 | $24.06 | D | |
Stock Option (Right to Buy)(11) | 03/25/2005(12) | 03/25/2014 | Common Stock | 25,000 | $23.64 | D |
Explanation of Responses: |
1. Includes 5,000 shares of restricted stock granted to the Reporting Person under the Issuer's 1997 Stock Option Plan, which shares vest and become non-forfeitable under the circumstances described in the Restricted Stock Agreement entered into between the Issuer and the Reporting Person. Also includes 225 shares of Common Stock in which the Reporting Person has a beneficial ownership interest under the Issuer's 401(k) Associate Savings Plan. |
2. Stock Option (Right to Buy) granted to the Reporting Person under the Issuer's 1997 Stock Option Plan in a transaction exempt under Rule 16b-3 of the Securities Exchange Act of 1934, as amended. |
3. The option became exercisable in 33 1/3% increments on each of the first, second and third anniversary dates of the December 4, 1998 option grant date. |
4. The option became exercisable in 33 1/3% increments on each of the first, second and third anniversary dates of the February 14, 2000 option grant date. |
5. Represents vested and unexercised options from the 25,000 share option grant made to the Reporting Person on February 14, 2000. |
6. Stock Option (Right to Buy) granted to the Reporting Person under the Issuer's 1991 Stock Option Plan in a transaction exempt under Rule 16b-3 of the Securities Exchange Act of 1934, as amended. |
7. The option became exercisable in 33 1/3% increments on each of the first, second and third anniversary dates of the February 9, 2001 option grant date. |
8. The option became exercisable in 33 1/3% increments on each of the first, second and third anniversary dates of the October 18, 2001 option grant date. |
9. The option becomes exercisable in 25% increments on each of the first, second, third and fourth anniversary dates of the August 12, 2002 option grant date. |
10. The option becomes exercisable in 25% increments on each of the first, second, third and fourth anniversary dates of the February 20, 2003 option grant date. |
11. Stock Option (Right to Buy) granted to the Reporting Person under the Issuer's 2002 Stock Option Plan in a transaction exempt under Rule 16b-3 of the Securities Exchange Act of 1934, as amended. |
12. The option becomes exercisable in 25% increments on each of the first, second, third and fourth anniversary dates of the March 25, 2004 option grant date. |
/s/ David W. Olson | 05/19/2005 | |
** 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 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. |