-----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, K9nO+BVsyrT1jRkhA+DmGyI9j1R4e7jt5oX7nF6r0H/fWuWTwl3ojs4BmjErFzuq F2P1bG39A68wKBClPaxHKQ== 0000709878-03-000029.txt : 20030402 0000709878-03-000029.hdr.sgml : 20030402 20030402120124 ACCESSION NUMBER: 0000709878-03-000029 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030401 FILED AS OF DATE: 20030402 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: JACOBS GARY CENTRAL INDEX KEY: 0001179661 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08506 FILM NUMBER: 03635873 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 4 1 gjacobsform44-2003.txt FORM 4 GARY JACOBS 1. Name and Address of Reporting Person Jacobs, Gary 6 International Drive Suite 190 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/Day/Year 04/01/2003 5. If Amendment, Date of Original (Month/Day/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/ +-----+---+-----------+---+----------+Reported | Indirect| Owner- | | | Year) | Year) |Code |V |Amount |A/D|Price |Transaction(s)| (I) | ship | +------------------------------+----------+----------+-----+---+-----------+---+----------+--------------+-----------+------------+ Common Stock 04/01/2003 A 11491 A $5.5700 64787 D
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| |direct |Owner-| |Security |Security|Year) |Year) |Code |V |(A) |(D) |cisable |tion Date |Title |Shares |Security | |(I) |ship | +----------+--------+-------+-------+------+--+-----+-----+----------+----------+-------+--------+----------+-------+-------+------+ Stock $3.8 08/10/2010 Common 20000 D Options Stock (Right to buy) Stock $3.88 02/28/2011 Common 10000 D Options Stock (Right to buy) Stock $5.57 04/01/2 A 15000 04/01/2006 04/01/2008 Common 15000 $0.0000 15000 D Options 003 Stock (Right to buy) Stock $6.45 03/28/2012 Common 50000 D Options Stock (Right to buy) Explanation of Responses: Exercisable over a 3-year period; 33% on 4/1/04, 67% on 4/1/05 and 100% 4/1/06.
SIGNATURE OF REPORTING PERSON /s/ Gary Jacobs DATE 04/01/2003 -----END PRIVACY-ENHANCED MESSAGE-----