FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
CAREMARK ULYSSES HOLDING CORP. [ UAM ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 04/29/2011 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 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 | ||||||
Common Stock(1) | 04/29/2011 | D | 7,383 | D | (2) | 0 | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Securities Underlying Derivative Security (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: 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 | ||||||||
Stock Option (Right to Buy) | $11.75 | 04/29/2011 | D | 5,000 | (3) | 05/25/2011 | Common Stock | 5,000 | $11.75 | 0 | D | ||||
Stock Option (Right to Buy) | $18.53 | 04/29/2011 | D | 10,000 | (3) | 08/22/2012 | Common Stock | 10,000 | $18.53 | 0 | D | ||||
Stock Option (Right to Buy) | $9.42 | 04/29/2011 | D | 10,000 | (3) | 06/03/2013 | Common Stock | 10,000 | $9.42 | 0 | D | ||||
Stock Option (Right to Buy) | $7 | 04/29/2011 | D | 12,600 | (3) | 06/04/2014 | Common Stock | 12,600 | $7 | 0 | D | ||||
Stock Option (Right to Buy) | $12.83 | 04/29/2011 | D | 12,600 | (3) | 06/02/2015 | Common Stock | 12,600 | $12.83 | 0 | D |
Explanation of Responses: |
1. Includes common stock and restricted shares, in each case that were exchangeable in the merger (the "Merger") contemplated by the Agreement and Plan of Merger, dated December 30, 2010, by and between the issuer, CVS Caremark Corporation and Ulysses Merger Sub, L.L.C. (as amended, the "Merger Agreement") for (a) $14.00 in cash and (b) one share of common stock, par value $0.01 per share, of Universal American Spin Corp. (subsequently renamed Universal American Corp. ) (the "New UAM Common Stock"). New UAM Common Stock closed at $9.33 per share on the first full trading day after the closing date of the Merger. |
2. Disposed of pursuant to the Merger Agreement in exchange for (a) $14.00 in cash and (b) one share of New UAM Common Stock, for each share owned. |
3. Stock options canceled in the Merger in exchange for an amount equal to $23.34 (the issuer's closing stock price on April 28, 2011, the last full trading day immediately prior to the closing date of the Merger) less the applicable exercise price of stock options (such amount being referred to as the "Option Payment"). The Option Payment is payable 50% in cash and 50% by delivery of shares of New UAM Common Stock. |
/s/ Tony L. Wolk | 04/29/2011 | |
** 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. | ||
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 Number. |