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OMB APPROVAL
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OMB Number 3235-0362
Expires: September 30, 1998
Estimated average burden
hours per response.............. 1.0
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FORM 5
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
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*
Jeffries Michael A.
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(Last) (First) (Middle)
15300 N. 90th Street, Suite 100
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(Street)
Scottsdale, Arizona 85260
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(City (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
RainTree Healthcare Corporation f/k/a
Unison Healthcare Corporation
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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, 1998
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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)
[X] Director [ ] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
President & Chief Executive Officer
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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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<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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</TABLE>
* 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.
<PAGE>
<TABLE>
<CAPTION>
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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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<S> <C> <C> <C> <C> <C>
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<CAPTION>
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-
Secu- eficially Direct ship
ity Owned (D) or (Instr. 4)
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Year (I)
Date Expira- Amount or (Instr. 4) (Instr. 4)
Exer- tion Number of
cisable Date Title Shares
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<S> <C> <C> <C> <C> <C> <C> <C>
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</TABLE>
Explanation of Responses:
Under a Debtors' first Amended Joint Plan of Reorganization, dated October 15,
1998, as supplemented and amended (the "Plan"), which Plan was confirmed by a
final order (the "Confirmation Order") of the United States Bankruptcy Court for
the District of Arizona (Case No. B-98-06583-PHX-GBN) dated January 29, 1999,
which order has become final and non-appealable, all of the interests in the
Company's Common Stock, including all options related thereto, were terminated.
The Company has not issued any New Common Stock (as defined in the Plan), or
options related thereto, to the Reporting Person.
/s/ Michael A. Jeffries February 12, 1999
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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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