-----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, KaBGzFEoffttZfcKI42UWxidHxdBbI6aTXzqb6f9b+0uFFkpBKf5klqYlUztqtQo 2NSy01b7b95FdpjaLn7e6Q== 0000709878-03-000022.txt : 20030213 0000709878-03-000022.hdr.sgml : 20030213 20030213111549 ACCESSION NUMBER: 0000709878-03-000022 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: WEHNER WILLIAM E CENTRAL INDEX KEY: 0001179662 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 5 MAIL ADDRESS: STREET 1: SIX INTERNATIONAL DR STREET 2: STE 190 CITY: RYE BROOK STATE: NY ZIP: 10573-1068 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: 03557246 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 wwehnerform5-2002.txt FORM 5 WILLIAM WEHNER 1. Name and Address of Reporting Person Wehner, William E. 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 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) President of Subsidiary 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 | +------------------------------+----------+----------+---------+-----------+---+----------+--------------+-----------+------------+ Preferred Stock 0 D Common Stock 12/31/2002 J 766 A $0.0000 460920 D Common Stock 125000 I Wife (Donna)
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 $2 12/10/2006 Common 30000 D Options Stock (Right to buy) Stock $2.25 12/14/2005 Common 10000 D Options Stock (Right to buy) Stock $2.25 12/08/2008 Common 20000 D Options Stock (Right to buy) Stock $2.62 05/28/2008 Common 50000 D Options Stock (Right to buy) Stock $2.75 12/09/2007 Common 15000 D Options Stock (Right to buy) Stock $3.12 06/14/2004 Common 15000 D Options Stock (Right to buy) Stock $3.15 08/01/2009 Common 187500 D Options Stock (Right to buy) Stock $3.88 02/28/2011 Common 37500 D Options Stock (Right to buy) Stock $4.09 04/01/2010 Common 30000 D Options Stock (Right to buy) Stock $6.45 03/28/2012 Common 30000 D Options Stock (Right to buy) Explanation of Responses: Shares purchased through 401(k) plan.
SIGNATURE OF REPORTING PERSON /s/ William E. Wehner DATE 02/13/2003 -----END PRIVACY-ENHANCED MESSAGE-----