-----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, Iue49LqDHO5HtyzJ5GFXBxdVjMTX341SWuAUi+SnOHXAAo1VNWx8/NhFboMel9jD 77pCBRvJ01Ht4JhZNqUYAg== 0001179110-05-016848.txt : 20050822 0001179110-05-016848.hdr.sgml : 20050822 20050822182507 ACCESSION NUMBER: 0001179110-05-016848 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050822 FILED AS OF DATE: 20050822 DATE AS OF CHANGE: 20050822 ISSUER: 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 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: FOUNDATION HEALTH SYSTEMS INC DATE OF NAME CHANGE: 19970513 FORMER COMPANY: FORMER CONFORMED NAME: HEALTH SYSTEMS INTERNATIONAL INC DATE OF NAME CHANGE: 19940207 FORMER COMPANY: FORMER CONFORMED NAME: HN MANAGEMENT HOLDINGS INC/DE/ DATE OF NAME CHANGE: 19931213 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MAYHEW KARIN D CENTRAL INDEX KEY: 0001213932 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12718 FILM NUMBER: 051042144 BUSINESS ADDRESS: BUSINESS PHONE: 8186766000 MAIL ADDRESS: STREET 1: 21650 OXNARD STREET, 22ND FLOOR CITY: WOODLAND HILLS STATE: CA ZIP: 91367 4 1 edgar.xml FORM 4 - X0202 4 2005-08-22 0 0000916085 HEALTH NET INC HNT 0001213932 MAYHEW KARIN D 21650 OXNARD STREET WOODLAND HILLS CA 91367 0 1 0 0 SVPOrganization Effectiveness Common Stock 2005-08-22 4 F 0 1788 42.31 D 16196 D Shares forfeited in lieu of payment of tax liability in connection with the vesting of a 5,000 share restricted stock grant made to the Reporting Person on August 12, 2002. The price used to calculate the number of shares forfeited to the Issuer by the Reporting Person was based on the closing price of the Issuer's common stock on August 12, 2005 (the vesting date of the August 12, 2002 restricted stock grant). The Reporting Person notified the Issuer on August 22, 2005 of her intent to forfeit shares to satisfy payment of the tax liability on the vested shares. Includes 1,984 shares of common stock owned by the Reporting Person's son and indirectly held by the Reporting Person. The Reporting Person disclaims beneficial ownership of all such shares held by her son and this report should not be deemed an admission that the Reporting Person is the beneficial owner of such shares for purposes of Section 16 or for any other purpose. /s/ Karin D. Mayhew 2005-08-22 -----END PRIVACY-ENHANCED MESSAGE-----