-----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, BUwXqozN+msKhmDrmuu3Q639xzBGJCIzgeithr2KuCi31t7md7Vo7H58xdc+J4PJ R5JEkOFgG+otphjv3SJjAQ== 0000904454-07-000738.txt : 20070928 0000904454-07-000738.hdr.sgml : 20070928 20070928181946 ACCESSION NUMBER: 0000904454-07-000738 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20070918 FILED AS OF DATE: 20070928 DATE AS OF CHANGE: 20070928 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: UNIVERSAL AMERICAN FINANCIAL CORP CENTRAL INDEX KEY: 0000709878 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 112580136 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CARSON RUSSELL L CENTRAL INDEX KEY: 0001212986 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08506 FILM NUMBER: 071143798 BUSINESS ADDRESS: BUSINESS PHONE: 2128939500 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 3 1 edgar.xml PRIMARY DOCUMENT X0202 3 2007-09-18 0 0000709878 UNIVERSAL AMERICAN FINANCIAL CORP UHCO 0001212986 CARSON RUSSELL L C/O WELSH, CARSON, ANDERSON AND STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 Common Stock 2083500 I By Welsh, Carson, Anderson & Stowe X, L.P. Common Stock 8244625 I By Welsh, Carson, Anderson & Stowe IX, L.P. Common Stock 23540 D Common Stock 17437 I By WCAS Management Corporation Series A Preferred Stock Series B Preferred Stock 5000 I By Welsh, Carson, Anderson & Stowe X, L.P. Series B Preferred Stock 20.00 Common Stock 4415700 I By Welsh, Carson, Anderson & Stowe X, L.P. Series B Preferred Stock 20.00 Common Stock 800 I By WCAS Management Corporation The Reporting Person is a managing member of the sole general partner of Welsh, Carson, Anderson & Stowe X, L.P. Pursuant to Instruction (5)(b)(iv) of Form 3, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. The Reporting Person is a managing member of the sole general partner of Welsh, Carson, Anderson & Stowe IX, L.P. Pursuant to Instruction (5)(b)(iv) of Form 3, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. Subject to certain conditions, the shares of Series A Preferred Stock are exchangeable for a correspoinding number of shares of Series B Preferred Stock at the option of the holder thereof. There is no applicable expiration date. Each share of Series B Preferred Stock is convertible into 100 shares of Common Stock at any time at the option of the holder thereof, subject to certain conditions, for no additional consideration. The Reporting Person is a controlling stockholder of WCAS Management Corporation. Pursuant to Instruction (5)(b)(iv) of Form 3, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. /s/ David Mintz, Attorney-in-fact 2007-09-28 -----END PRIVACY-ENHANCED MESSAGE-----