-----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, VdvtlQBtXzJdMk6jUyIIEISoXTaz1JQM1pRClHh5KAAN1GZd0YA+S53o3g2DjgqS 52MymCxPCWrCn8MlB0iALA== 0001013220-04-000106.txt : 20041203 0001013220-04-000106.hdr.sgml : 20041203 20041203105127 ACCESSION NUMBER: 0001013220-04-000106 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: PISANO JANE G CENTRAL INDEX KEY: 0001243396 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13083 FILM NUMBER: 041182294 BUSINESS ADDRESS: STREET 1: C/O WELLPOINT HEALTH NETWORKS STREET 2: 1 WELLPOINT WAY CITY: THOUSAND OAKS STATE: CA ZIP: 91362 BUSINESS PHONE: 8055576119 MAIL ADDRESS: STREET 1: 900 EXPOSITION BLVD CITY: LOS ANGELES STATE: CA ZIP: 90007 4 1 edgar.xml PRIMARY DOCUMENT X0202 4 2004-11-30 1 0001013220 WELLPOINT HEALTH NETWORKS INC /DE/ WLP:NYSE 0001243396 PISANO JANE G 1 WELLPOINT WAY THOUSAND OAKS CA 91362 1 0 0 0 Common Stock 2004-11-30 4 D 0 6700 D 0 D Stock Option (right to buy) 68.33 2004-11-30 4 D 0 4000 0 D 2006-02-05 2013-02-05 Common Stock 4000 20000 D Stock Option (right to buy) 79.24 2004-11-30 4 D 0 16000 0 D 2012-06-26 Common Stock 16000 4000 D Stock Option (right to buy) 101.75 2004-11-30 4 D 0 4000 0 D 2007-01-26 2014-01-26 Common Stock 4000 0 D Disposed of pursuant to an Amended and Restated Agreement and Plan of Merger between issuer, Anthem, Inc. and Anthem Holding Corp. for one share of Anthem, Inc. common stock and $23.80 cash for each share of Issuer common stock. 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 vested as of the Transaction Date with respect to 12,000 shares and 4,000 options will vest on June 27, 2005. /s/ Monica M. Chizzo - Attorney-in-fact 2004-12-03 -----END PRIVACY-ENHANCED MESSAGE-----