-----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, PS9+G8yjruUdq9YUcLWgkb9rdZeh8NKn+Geyc4MRWLsZI5q+T0VKdDM+BaxCAdJk YEjP/zxugPeaREdHh9PaTA== 0000709878-02-000002.txt : 20020812 0000709878-02-000002.hdr.sgml : 20020812 20020812113303 ACCESSION NUMBER: 0000709878-02-000002 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20011231 FILED AS OF DATE: 20020812 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: UNIVERSAL AMERICAN FINANCIAL CORP CENTRAL INDEX KEY: 0000709878 STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311] IRS NUMBER: 112580136 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08506 FILM NUMBER: 02726090 BUSINESS ADDRESS: STREET 1: SIX INTERNATIONAL DRIVE STREET 2: SUITE 190 CITY: RYE BROOK STATE: NY ZIP: 10573-1068 BUSINESS PHONE: 9149345200X253 MAIL ADDRESS: STREET 1: SIX INTERNATIONAL DRIVE STREET 2: SUITE 190 CITY: RYE BROOK STATE: NY ZIP: 10573-1068 FORMER COMPANY: FORMER CONFORMED NAME: UNIVERSAL HOLDING CORP DATE OF NAME CHANGE: 19920703 COMPANY DATA: COMPANY CONFORMED NAME: BARASCH RICHARD A CENTRAL INDEX KEY: 0001076341 OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: UNIVERSAL AMERICAN FINANCIAL CORP STREET 2: SIX INTERNATIONAL DRIVE SUITE 190 CITY: RYE BROOK STATE: NY ZIP: 10573 BUSINESS PHONE: 9149348700 MAIL ADDRESS: STREET 1: C/O UNIVERSAL AMERICAN FINANCIAL CORP STREET 2: SIX INTERNATIONAL DRIVE SUITE 190 CITY: RYE BROOK STATE: NY ZIP: 10573 5 1 rbaraschform5-2001.txt RICHARD BARASCH FORM 5 2001 1. Name and Address of Reporting Person Barasch, Richard A. 6 International Drive Rye Brook, NY 10573 USA 2. Issuer Name and Ticker or Trading Symbol Universal American Financial Corp. (UHCO) 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year 2001 5. If Amendment, Date of Original (Month/Day/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) 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 |2. Trans- |3. Trans- |4. Securities Acquired (A) |5. Amount of |6. Owner- |7. Nature | | | action | action | or Disposed of (D) | Securities | ship | of In- | | | Date | Code | | Beneficially | Form: | direct | | | | | | Owned at | Direct | Bene- | | | (Month/ | | | End of | (D) or | ficial | | | Day/ | +-----------+------+----------+ Year | Indirect| Owner- | | | Year) | |Amount |A/D |Price | | (I) | ship | +---------------------------------+----------+-------------+-----------+------+----------+----------------+-----------+------------+ Common Stock 02/12/2001 G -3000 D $0.0000 D Common Stock 05/14/2001 G -1000 D $0.0000 D Common Stock 10/01/2001 G -1500 D $0.0000 D Common Stock 11/01/2001 G -2000 D $0.0000 D Common Stock 12/10/2001 G -1000 D $0.0000 D Common Stock 12/31/2001 G -1000 D $0.0000 D Common Stock 12/31/2001 J 38719 A $0.0000 1027130 D Common Stock 0 I Daughter (Emil) Common Stock 32830 I Son (Benjamin) Common Stock 423977 I Wife Common Stock 0 I Tara Acquisition Common Stock 39730 I Daughter (Natalie) Common Stock 409561 I Barasch Universal Trust Common Stock 0 I Norman Barasch Common Stock 34774 I Daughter (Emily) Common Stock 16376 I Tara Acquisition LLC Common Stock 67744 I Norman Barasch Trust #1 Common Stock 406297 I Norman Barasch Trust #2
TABLE II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
+-------------+--------+----------+---------+-----------+---------------------+----------------+----------+--------+-------+-------+ |1. |2. |3. |4. |5. |6. |7. |8. |9. |10. |11. | | | | | | | | | |Number |Owner- | | | | | | | | | | |of |ship | | | | | | | | | | |Deriv- |Form of| | | | | | | | |Title and Amount| |ative |Deriv- | | | | | | | | |of Underlying | |Secur- |ative |Nature | | |Conver- | | |Number of | |Securities | |ities |Secur- |of | | |sion or | | |Derivative |Date Exercisable +-------+--------+ |Benefi- |ity: |In- | | |Exercise| | |Securities |and Expiration Date | |Amount | |cially |Direct |direct | | |Price of|Transac- |Transac- |Acquired(A)|(Month/Day/Year) | |or | |Owned |(D) or |Bene- | |Title of |Deriv- |tion Date |tion Code|Disposed(D)+----------+----------+ |Number |Price of |at End |In- |ficial | |Derivative |ative |(Month/ | +-----+-----+Date Exer-|Expira- | |of |Derivative|of |direct |Owner- | |Security |Security|Day/Year) | |(A) |(D) |cisable |tion Date |Title |Shares |Security |Year |(I) |ship | +-------------+--------+----------+---------+-----+-----+----------+----------+-------+--------+----------+--------+-------+-------+ Stock Options $2.2 12/10/2006 Common 40000 D (Right to buy) Stock Stock Options $2.25 12/08/2008 Common 25000 D (Right to buy) Stock Stock Options $2.48 12/14/2005 Common 20000 D (Right to buy) Stock Stock Options $2.62 05/28/2008 Common 143000 D (Right to buy) Stock Stock Options $3.03 12/09/2007 Common 25000 D (Right to buy) Stock Stock Options $3.15 08/01/2009 Common 600000 D (Right to buy) Stock Stock Options $3.33 06/14/2004 Common 20000 D (Right to buy) Stock Stock Options $3.88 02/28/2011 Common 37500 D (Right to buy) Stock Stock Options $4.09 04/01/2010 Common 37500 D (Right to buy) Stock Explanation of Responses: Shares purchased through 401(k) plan. (Note: includes shares acquired prior to 1/1/2001 that were not previously reported.)
SIGNATURE OF REPORTING PERSON /s/ Richard A. Barasch DATE 08/12/2002 -----END PRIVACY-ENHANCED MESSAGE-----