-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, QpIvNJU1ELuQpEbtcgq6/0TNTkSvjfQKSKa6fBhEHcczZDli6fj8HZZOKJfLFYK6 IofZaKqWOIUhpUxpWrb6Xg== 0001013220-04-000102.txt : 20041203 0001013220-04-000102.hdr.sgml : 20041203 20041203104314 ACCESSION NUMBER: 0001013220-04-000102 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041130 FILED AS OF DATE: 20041203 DATE AS OF CHANGE: 20041203 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: WELLPOINT HEALTH NETWORKS INC /DE/ CENTRAL INDEX KEY: 0001013220 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 954635504 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1 WELLPOINT WAY CITY: THOUSAND OAKS STATE: CA ZIP: 91362 BUSINESS PHONE: 8187034000 MAIL ADDRESS: STREET 1: 1 WELLOINT WAY CITY: THOUSAND OAKS STATE: CA ZIP: 91362 FORMER COMPANY: FORMER CONFORMED NAME: BLUE CROSS OF CALIFORNIA /CA/ DATE OF NAME CHANGE: 19960508 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SCHAEFFER LEONARD D CENTRAL INDEX KEY: 0001016369 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13083 FILM NUMBER: 041182264 BUSINESS ADDRESS: STREET 1: C/O WELLPOINT HEALTH NETWORKS STREET 2: 1 WELLPOINT WAY CITY: THOUSAND OAKS STATE: CA ZIP: 91362 BUSINESS PHONE: 8055576000 MAIL ADDRESS: STREET 1: 2525 DUPONT DRIVE CITY: IRVINE STATE: CA ZIP: 92715 4 1 edgar.xml PRIMARY DOCUMENT X0202 4 2004-11-30 0001013220 WELLPOINT HEALTH NETWORKS INC /DE/ WLP:NYSE 0001016369 SCHAEFFER LEONARD D 1 WELLPOINT WAY THOUSAND OAKS CA 91362 1 1 0 0 Chairman & CEO Employee Stock Option (right to buy) 93.49 2004-11-30 4 D 0 86322 0 D 2008-02-11 Common Stock 86322 1158960 D Employee Stock Option (right to buy) 93.49 2004-11-30 4 D 0 7205 0 D 2006-03-03 Common Stock 7205 1151755 D Employee Stock Option (right to buy) 101.75 2004-11-30 4 D 0 291700 0 D 2014-01-25 Common Stock 291700 860055 D Employee Stock Option (right to buy) 108.75 2004-11-30 4 D 0 7484 0 D 2007-02-10 Common Stock 7484 852571 D Employee Stock Option (right to buy) 108.77 2004-11-30 4 D 0 179956 0 D 2010-02-10 Common Stock 179956 672615 D Employee Stock Option (right to buy) 108.77 2004-11-30 4 D 0 57318 0 D 2008-02-11 Common Stock 57318 615297 D Employee Stock Option (right to buy) 108.77 2004-11-30 4 D 0 49968 0 D 2010-03-01 Common Stock 49968 565329 D Employee Stock Option (right to buy) 111.54 2004-11-30 4 D 0 75976 0 D 2006-03-04 Common Stock 75976 489353 D Employee Stock Option (right to buy) 111.54 2004-11-30 4 D 0 90936 0 D 2007-02-10 Common Stock 90936 398417 D Employee Stock Option (right to buy) 111.54 2004-11-30 4 D 0 1334 0 D 2010-02-10 Common Stock 1334 397083 D Employee Stock Option (right to buy) 111.54 2004-11-30 4 D 0 112621 0 D 2011-01-31 Common Stock 112621 284462 D Employee Stock Option (right to buy) 111.54 2004-11-30 4 D 0 203540 0 D 2009-02-10 Common Stock 203540 80922 D Employee Stock Option (right to buy) 111.54 2004-11-30 4 D 0 80922 0 D 2011-06-03 Common Stock 80922 0 D Disposed of pursuant to the Amended and Restated Agreement and Plan of Merger between Issuer, Anthem, Inc., Anthem Holding Corp. in connection with the assumptions of such option by Anthem, Inc. and its resulting conversion into an option to acquire shares of Anthem, Inc. common stock at an adjusted exercise price per share, all in accordance with the option exchange ratio set forth in such Agreement and Plan of Merger. The options are fully vested as of the Transaction Date. The options are vested as of the Transaction Date with respect to 48,616 shares and 48,616 options will vest on January 26, 2005, 48,617 options will vest on July 26, 2005, 48,617 options will vest on January 26, 2006, 48,617 options will vest on July 26, 2006 and 48,617 options will vest on January 26, 2007. /s/ Monica M. Chizzo - Attorney-in-fact 2004-12-03 -----END PRIVACY-ENHANCED MESSAGE-----