Statement of Changes in Beneficial Ownership (4)
March 15 2018 - 4:42PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
ZIELINSKI THOMAS C
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2. Issuer Name
and
Ticker or Trading Symbol
Anthem, Inc.
[
ANTM
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
EVP & General Counsel
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(Last)
(First)
(Middle)
120 MONUMENT CIRCLE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
3/13/2018
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(Street)
INDIANAPOLIS, IN 46204
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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3/13/2018
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M
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3000
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A
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$108.35
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29084
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D
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Common Stock
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3/13/2018
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M
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5588
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A
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$146.93
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34672
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D
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Common Stock
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3/13/2018
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M
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6763
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A
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$131.80
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41435
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D
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Common Stock
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3/13/2018
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M
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5104
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A
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$166.97
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46539
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D
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Common Stock
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3/13/2018
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S
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14255
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D
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$228.98
(1)
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32284
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D
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Common Stock
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3/13/2018
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S
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6200
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D
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$229.80
(2)
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26084
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (Right to Buy)
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$108.35
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3/13/2018
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M
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3000
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(3)
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6/2/2021
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Common Stock
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3000
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$0
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4064
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D
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Employee Stock Option (Right to Buy)
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$146.93
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3/13/2018
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M
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5588
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(4)
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3/2/2025
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Common Stock
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5588
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$0
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0
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D
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Employee Stock Option (Right to Buy)
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$131.80
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3/13/2018
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M
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6763
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(5)
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3/1/2026
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Common Stock
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6763
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$0
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6764
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D
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Employee Stock Option (Right to Buy)
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$166.97
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3/13/2018
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M
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5104
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(6)
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3/1/2027
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Common Stock
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5104
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$0
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10210
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D
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Explanation of Responses:
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(1)
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This transaction was executed in multiple trades at prices ranging from $228.49 to $229.47. The price reported reflects the weighted average sale price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.
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(2)
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This transaction was executed in multiple trades at prices ranging from $229.50 to $230.22. The price reported reflects the weighted average sale price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.
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(3)
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The option represents a right to purchase a total of 21,191 shares, and is exercisable in six semi-annual installments with one installment of 3,531 shares and five installments of 3,532 shares each beginning on December 2, 2014, which is the six-month anniversary of the date on which the option was granted.
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(4)
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The option, representing a right to purchase a total of 16,762 shares and is exercisable in six semi annual installments with two installments of 2,793 shares each and four installments of 2,794 shares each beginning on September 2, 2015, which is the six-month anniversary of the date on which the option was granted.
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(5)
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The option represents a right to purchase a total of 20,289 shares, and is exercisable in six semi-annual installments, with three installments of 3,381 shares each and three installments of 3,382 shares each, beginning on September 1, 2016, which is the six-month anniversary of the option grant date.
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(6)
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The option represents a right to purchase a total of 15,314 shares, and is exercisable in six semi-annual installments, with four installments of 2,552 shares each and two installments of 2,553 shares each, beginning on September 1, 2017, which is the six-month anniversary of the option grant date.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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ZIELINSKI THOMAS C
120 MONUMENT CIRCLE
INDIANAPOLIS, IN 46204
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EVP & General Counsel
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Signatures
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/s/ Kathleen S. Kiefer, Attorney in fact
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3/15/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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