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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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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FORM 4 OMB APPROVAL
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[ ] CHECK THIS BOX IF NO LONGER OMB Number: 3235-0287
SUBJECT TO SECTION 16. FORM 4 Expires: September 30, 1998
OR FORM 5 OBLIGATIONS MAY Estimated average burden
CONTINUE. SEE INSTRUCTION 1(B). hours per response .... 0.5
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1. Name and Address of Reporting Person
Long Michael T.
(Last) (First) (Middle)
c/o Brown Brothers Harriman & Co., 63 Wall Street
(Street)
New York NY 10021
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
WellCare Management Group, Inc./WELL
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Statement of Month/Year
1/98
5. If Amendment, Date or Original (Month/Year)
6. Relationship of Reporting Person to Issuer (Check all applicable)
Director X 10% Owner
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Officer (give title Other
----- below) ----- (specify
below)
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7. Individual or Join/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
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Form filed by More than One Reporting Person
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TABLE I-- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
1. Title of Security 2. Transaction 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
(Instr. 3) Date action or Disposed of (D) Securities ship of In-
Code (Instr. 3, 4 and 5) Beneficially Form: direct
(Month/ (Instr. 8) Owned at Direct Bene-
Day/ ------------- ------------------------- End of (D) ficial
Year) (A) Month Indirect Owner-
Code Amount or Price (Instr. 3 (I) ship
(D) and 4) (Instr. 4) (Instr. 4)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
* If the form is filed by more than one reporting person, SEE Instruction 4(b)(v). SEC 1474 8-92)
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FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- 6. Date Exer-
Security (Instr. 3) sion or action tion Code ative Securities Ac- cisable and Ex-
Exercise Date (Instr. 8) quired (A) or Dis- piration Date
Price of posed of (D)
Deriv- (Month/ (Instr. 3, 4 and 5) (Month/Day/
ative Day/ Year)
Security Year) ------------- ------------------------- ----------------------
Date Expira-
Code (A) (D) Exer- tion
cisable Date
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8% Senior Subordinated Convertible
Note due 12/31/02 (the "Note") $4.00 (1) 1/14/98 (2) J (2) N/A N/A Immed. (3) 12/31/02
8% Senior Subordinated Convertible
Note due 12/31/02 (the "Note") $8.00 (1) 1/14/98 (2) J (2) N/A N/A Immed. (3) 12/31/02
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7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na-
Underlying Securities Deriv of Deriv- ship ture
ative ative Form of In-
(Instr. 3 and 4) Secur- Secur- of De- direct
ity ities rivative Bene-
(Instr. Bene Secu- ficial
5) ficially rity: Own-
Owned Direct ership
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Amount or of Indi-
Title Number of Month rect (I)
Shares (Instr. 4) (Instr. 4)
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Common Stock 1,250,000 (2) (2) I (4)
Common Stock 1,875,000 (2) (2) I (4)
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Explanation of Responses:
(1) Subject to anti-dilution protection.
(2) The Note, in an aggregate principal amount of $20,000,000, was amended on
January 14, 1998 to provide that the conversion price shall be (i) $4.00 as
to $5,000,000 principal amount of the Note; and (ii) $8.00 as to $15,000,000
principal amount of the Note.
(3) Subject to prior approval of the Commissioner of Health of the State of New
York.
(4) By The 1818 Fund II, L.P. (the "Fund"). Mr. Long is a general partner of
Brown Brothers Harriman & Co. ("BBH"), the general partner of the Fund and
one of two general partners of BBH having voting power (including the power
to vote or direct the voting) and investment power (including the power to
dispose or direct the disposition) with respect to securities of the issuer
owned by the Fund. The amounts reported herein represent 100% of the
securities beneficially owned by the Fund. Mr. Long's pecuniary interest
in the securities is limited to his percentage interest in BBH's interest
in such securities.
**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 provided 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.
/s/ T. Michael Long January 30, 1998
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**Signature of Reporting Person Date
