-----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, KQYv8Y2GP+5l0/ygyXEKa4S8nkR3ywPgtsZ2HK1Bf1UMeQwDLbfgwA2IOIH9m+aR E0klNZT4KhrXox44Rmq8fw== 0001104659-03-004741.txt : 20030324 0001104659-03-004741.hdr.sgml : 20030324 20030321194629 ACCESSION NUMBER: 0001104659-03-004741 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030220 FILED AS OF DATE: 20030324 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: HEALTH NET INC CENTRAL INDEX KEY: 0000916085 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 954288333 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12718 FILM NUMBER: 03613007 BUSINESS ADDRESS: STREET 1: 21650 OXNARD ST CITY: WOODLAND HILLS STATE: CA ZIP: 91367 BUSINESS PHONE: 8186766000 MAIL ADDRESS: STREET 1: 225 N MAIN ST CITY: PUEBLO STATE: CO ZIP: 81003 FORMER COMPANY: FORMER CONFORMED NAME: HN MANAGEMENT HOLDINGS INC/DE/ DATE OF NAME CHANGE: 19931213 FORMER COMPANY: FORMER CONFORMED NAME: HEALTH SYSTEMS INTERNATIONAL INC DATE OF NAME CHANGE: 19940207 FORMER COMPANY: FORMER CONFORMED NAME: FOUNDATION HEALTH SYSTEMS INC DATE OF NAME CHANGE: 19970513 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: GELLERT JAY M CENTRAL INDEX KEY: 0001213928 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 21650 OXNARD STREET, 22ND FLOOR CITY: WOODLAND HILLS STATE: CA ZIP: 91367 BUSINESS PHONE: 8186766000 MAIL ADDRESS: STREET 1: 21650 OXNARD STREET, 22ND FLOOR CITY: WOODLAND HILLS STATE: CA ZIP: 91367 4 1 j8746_4.htm 4

FORM 4

  o Check this box if no longer subject to Section 16.  Form 4 or Form 5 obligations may continue.
See Instruction 1(b).

(Print or Type Responses)

UNITED STATES SECURITIES AND EXCHANGE COMMISSION

Washington, D.C.  20549


STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section
17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the
Investment Company Act of 1940

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 1. Name and Address of Reporting Person *



Gellert,         Jay                       M.

(Last)            (First)              (Middle)


21650 Oxnard Street

(Street)


Woodland Hills,  CA       91367

(City)       (State)          (Zip)

 

 2. Issuer Name and Ticker
    or Trading Symbol

Health Net, Inc.   HNT



 3. I.R.S. Identification
    Number of Reporting
    Person, if an entity
    (voluntary)

 

 

 4. Statement for
    Month/Day/Year

February 20, 2003





 5. If Amendment, Date of
    Original (Month/Day/Year)

 

 


 6. Relationship of Reporting Person(s) to Issuer

     (Check all applicable)

      Director

 

   X   Officer (give title below)

 

      10% Owner

 

      Other (specify below)

President and Chief Executive Officer  


 7. 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 Acquired, Disposed of, or Beneficially Owned

 

1. Title of Security
(Instr. 3)

2. Transaction Date (Month/Day/
Year)

2A. Deemed Execution Date, if any (Month/Day/
Year)

3. Transaction Code
(Instr. 8)

4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)

5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)

6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)

7. Nature of Indirect Beneficial Ownership
(Instr. 4)

Code

V

Amount

(A) or (D)

Price

Class A Common Stock

2/20/03(1)

 

A(2)

 

130,000

A

N/A

165,000

D

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

 

1. Title of Derivative Security (Instr. 3)

2. Conversion or Exercise Price of Derivative Security

3. Transaction Date
(Month/Day/
Year)

3A. Deemed Execution Date, if any (Month/Day/
Year)

4. Transaction Code (Instr. 8)

5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)

6. Date Exercisable and Expiration Date
(Month/Day/Year)

7. Title and Amount of Underlying Securities
(Instr. 3 and 4)

8. Price of Derivative Security
(Instr. 5)

9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)

10. Ownership Form of Derivative Securities: Direct (D) or Indirect (I)
(Instr. 4)

11. Nature of Indirect Beneficial Ownership
(Instr. 4)

Code

V

(A)

(D)

Date
Exercisable

Expiration
Date

Title

Amount or Number of Shares

Option (Right to Buy) (3)

$24.06

2/20/03 (1)

 

A

 

325,000

 

(4)

2/20/13

Class A Common Stock

325,000

N/A

325,000

D

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Explanation of Responses:

 

 

 

       (1) Although the Issuer's Compensation and Stock Option Committee granted the restricted shares and the option to

             the Reporting Person on 2-20-03, since the Reporting Person is one of the two highest compensated executive officers

            of the Issuer, under the Issuer's By-laws such grants were subject to ratification of the full Board of Directors.  Such

            full Board of Directors ratification was received on 3-20-03, and this Form 4 was filed within two days of such ratification.

 

       (2) Restricted shares granted to the Reporting Person under the Issuer's 2002 Stock Option Plan in a transaction

             exempt under Rule 16b-3, which shares vest and become non-forfeitable to the extent of 50% of the shares three

             years after the date of grant (on February 20, 2006) and to the extent of the remaining 50% of the shares four years

            after the date of grant (on February 20, 2007) or upon the occurrence of such other circumstances described in the

            Restricted Stock Agreement between the Issuer and the Reporting Person.

 

       (3) Grant to the Reporting Person of an Option (Right to Buy) under the Issuer's 2002 Stock Option Plan in a transaction

             exempt under Rule 16b-3(d).

 

       (4) The Option becomes exercisable in 50% increments on each of the third and fourth anniversaries of the grant

             date (2-20-03).

 

 

 

 

 

 

 

/s/  Jay M. Gellert

 

3-21-03

** 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 4(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.

 

 

http://www.sec.gov/divisions/corpfin/forms/form4.htm

Last update: 09/05/2002

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