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FORM 5 OMB APPROVAL
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[ ] Check this box if no longer OMB Number 3235-0362
subject to Section 16. Form 4 Expires: September 30, 1998
or Form 5 obligations may continue. Estimated average burden
See Instruction 1(b). hours per response.............. 1.0
[ ] Form 3 Holdings Reported -------------------------------------
[ ] Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section
17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the
Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Henderson Paul G.
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(Last) (First) (Middle)
8800 N. Gainey Center Dr., Suite 245
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(Street)
Scottsdale, AZ 85258
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(City (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Unison HealthCare Corporation (UNHC)
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3. I.R.S. Identification
Number of Reporting
Person, if an entity
(Voluntary)
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4. Statement for Month/Year
December, 1997
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5. If Amendment, Date of Original
(Month/Year)
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ ] Director [ ] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
President, Sunbelt Therapy Management Services, Inc.
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7. Individual or Joint/Group Filing (Check Applicable Line)
[X] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
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<PAGE>
<TABLE>
<CAPTION>
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TABLE I--NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) or 5. Amount of 6. Owner- 7. Nature of
(Instr. 3) action action Disposed of (D) Securities Ben- ship Indirect
Date Code (Instr. 3, 4 and 5) eficially Owned Form: Di- Beneficial
(Month/ (Instr.8) at end of rect (D) Ownership
Day/ ---------------------------- Issuer's Fiscal or Indi- (Instr. 4)
Year) (A) or Year rect (I)
Amount (D) Price (Instr. 3 and 4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
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Common Stock 73,059 D
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* If the form is filed by more than one reporting person, see Instruction
4(b)(v). Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently valid OMB Number.
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Table II--DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriva-
(Instr. 3) sion or action tion tive Securities Ac-
Exer- Date Code quired (A) or Dis-
cise (Month/ (Instr.8) posed of (D)
Price of Day/ (Instr. 3,4, and 5)
Deriva- Year)
tive Se- -------------------
curity (A) (D)
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Option Grant(right to buy) $2.44 8/27/97 A 4,000
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Promissory note (2) 11/24/96 J(3)
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Guaranteed Payment (2) 11/24/96 J(3)
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6. Date Exercis- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Nature
able and Expi- Underlying Securities of of De- ship of of Indi-
ration Date (Instr. 3 and 4) De- rivative Deriva- rect Ben-
(Month/Day/ riva- Securi- tive Se- efcial
Year) tive ies Ben- curity: Owner-
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Date Expira- Amount or ity Owned at (D) or (Instr.4)
Exer- tion Number of (Instr. 5) End of Year Indirect
cisable Date Title Shares Year(Instr.4) (I)(Instr.4)
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(1) 8/27/07 Common Stock 4,000 -- 14,000 D
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1/5/98 1/5/98 Common Stock (3) -- D
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1/4/99 1/4/99 Common Stock (3) -- D
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Explanation of Responses:
(1) Of the shares underlying this option grant, 40% vest on 8/27/98, 20% vest
on 8/27/99, 20% vest on 8/27/00 and 20% vest on 8/27/01.
(2) The outstanding principal amount of this obligation ($813,125 in the
aggregate), is convertible into shares of common stock of the Company based
on the following conversion formula: note balance divided by the average
closing price of Unison Common Stock for the 20 trading days immediately
preceding the conversion date.
(3) In January 1997, effective 11/24/96, Unison purchased a 10% minority
interest in Sunbelt Therapy Management Services, Inc. In connection with
the purchase, Mr. Henderson received a promissory note in the amount of
$458,750 and is entitled to a guaranteed payment amounting to $354,375.
Under the terms of the note, up to 50% of the obligations are convertible
into shares of Unison Common Stock at the following rate: principal balance
may be converted into the number of shares of common stock derived by
dividing such amount by the average closing price of Unison Common Stock
for the 20 trading days immediately preceding the conversion date.
/s/ Paul G. Henderson February 17, 1998
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**Signature of Reporting Person Date
**Intentional misstatements or omissions of facts constitute Federal Criminal
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB Number.
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