-----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, FF4nWMQsvQbDcnfA2wnoI21LZgMkTUdhmt2BfNVA5sjFdc23opVrIG2mM/2KNLSW bhDg5nGFFeXkGkLktC4GXA== 0000709878-03-000013.txt : 20030213 0000709878-03-000013.hdr.sgml : 20030213 20030213111147 ACCESSION NUMBER: 0000709878-03-000013 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030213 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: COLLIFLOWER MICHAEL CENTRAL INDEX KEY: 0001203718 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: SIX INTERNATIONAL DR STREET 2: STE 190 CITY: RYE BROOK STATE: NY ZIP: 10573 BUSINESS PHONE: 9149345200 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: 03557222 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 5 1 mcolliflowerform5-2002.txt FORM 5 MICHAEL COLLIFLOWER 1. Name and Address of Reporting Person Colliflower, Michael A. Six 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 12/2002 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Vice President 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- |2A.Execu- |3. Trans-|4. Securities Acquired (A)|5. Amount of |6. Owner- |7. Nature | | | action | action | action| or Disposed of (D) |Securities | ship | of In- | | | Date | Date | Code | |Beneficially | Form: | direct | | | | | | |Owned | Direct | Bene- | | | (Month/ | (Month/ | | |Following | (D) or | ficial | | | Day/ | Day/ | +-----------+---+----------+ Year | Indirect| Owner- | | | Year) | Year) | |Amount |A/D|Price | | (I) | ship | +------------------------------+----------+----------+---------+-----------+---+----------+--------------+-----------+------------+
TABLE II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
+----------+--------+-------+-------+---------+-----------+---------------------+----------------+----------+-------+-------+------+ |1. |2. |3. |3A. |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- |Trans- |Execu- | |Number of | |Securities | |ities |Secur- |of | | |sion or |action |tion | |Derivative |Date Exercisable +-------+--------+ |Benefi-|ity: |In- | | |Exercise|Date |Date | |Securities |and Expiration Date | |Amount | |cially |Direct |direct| | |Price of| | |Transac- |Acquired(A)|(Month/Day/Year) | |or | |Owned |(D) or |Bene- | |Title of |Deriv- |(Month/|(Month/|tion Code|Disposed(D)+----------+----------+ |Number |Price of | |In- |ficial| |Derivative|ative |Day/ |Day/ | +-----+-----+Date Exer-|Expira- | |of |Derivative|at End |direct |Owner-| |Security |Security|Year) |Year) | |(A) |(D) |cisable |tion Date |Title |Shares |Security |of Year|(I) |ship | +----------+--------+-------+-------+---------+-----+-----+----------+----------+-------+--------+----------+-------+-------+------+ Stock $4.75 10/28/2012 Common 10000 D Options Stock (Right to buy) Explanation of Responses:
SIGNATURE OF REPORTING PERSON /s/ Michael A. Colliflower DATE 02/13/2003 -----END PRIVACY-ENHANCED MESSAGE-----