-----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, LnRJsPKb/U0lOmdmHA1Yoj7FkFoC43MeCVtz5X3eaiq4IQEycC34qxqVvPs7DgDX qD//DZVvtJDuzbsuSpYoyw== 0001249615-04-000001.txt : 20040204 0001249615-04-000001.hdr.sgml : 20040204 20040204164713 ACCESSION NUMBER: 0001249615-04-000001 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040204 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HICKEY KEVIN F CENTRAL INDEX KEY: 0001249615 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13591 FILM NUMBER: 04567393 BUSINESS ADDRESS: STREET 1: HEALTHAXIS STREET 2: 5215 N. O'CONNOR BLVD. CITY: IRVING STATE: TX ZIP: 75039 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HEALTHAXIS INC CENTRAL INDEX KEY: 0000768892 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING SERVICES [7371] IRS NUMBER: 232214195 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2500 DEKALB PIKE CITY: NORRISTOWN STATE: PA ZIP: 19401 BUSINESS PHONE: 6102792500 MAIL ADDRESS: STREET 1: 2500 DEKALB PIKE STREET 2: PO BOX 511 CITY: NORRISTOWN STATE: PA ZIP: 19404-0511 FORMER COMPANY: FORMER CONFORMED NAME: PROVIDENT AMERICAN CORP DATE OF NAME CHANGE: 19920703 5 1 edgar.xml PRIMARY DOCUMENT X0201 5 2003-12-31 0 1 0000768892 HEALTHAXIS INC HAXS 0001249615 HICKEY KEVIN F 5215 N. O'CONNOR BLVD. SUITE 800 IRVING TX 75039 1 0 0 0 Employee Stock Option (right to buy) 3.30 2003-01-14 4 A 0 L 2250 A 2003-10-29 2013-01-14 Common Stock 2250 5260 D No price is applicable for the option. Kevin F. Hickey 2004-02-04 -----END PRIVACY-ENHANCED MESSAGE-----