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