Schedule 13G

Filed by: ROTH WILLIAM HAROLD
Total Shares: 265,435
Subject Company: Unico American Corp. - View Complete Ownership History Backtest
Filed as of Date: 09/20/2019
Event Date: 09/18/2019
Overall % Ownership: 5.0
Theoretical performance if you bought this security on the day the filing was released.
Perf 1d Perf 5d Perf 1m Perf 6m Perf 1y Max Gain # Days to Max Gain Max Loss # Days to Max Loss
-4.8287 3.4268 4.9065 9.5015 16 -5.919 3

Reporting Persons

Name Sole
Voting Power
Shared
Voting Power
Sole
Dispositive Power
Shared
Dispositive Power
Aggregate
Amount Owned
Percent
of class
William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 0 265,435 0 265,435 265,435 5.00%
Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 0 265,435 0 265,435 265,435 5.00%
View Original Filing on Edgar's

Raw Filing Contents

0001683168-19-003007.txt : 20190923
0001683168-19-003007.hdr.sgml : 20190923
20190923085210
ACCESSION NUMBER:		0001683168-19-003007
CONFORMED SUBMISSION TYPE:	SC 13G
PUBLIC DOCUMENT COUNT:		2
FILED AS OF DATE:		20190920
DATE AS OF CHANGE:		20190923
GROUP MEMBERS:		AMY ROTH
GROUP MEMBERS:		WILLIAM ROTH

SUBJECT COMPANY:	

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			UNICO AMERICAN CORP
		CENTRAL INDEX KEY:			0000100716
		STANDARD INDUSTRIAL CLASSIFICATION:	FIRE, MARINE & CASUALTY INSURANCE [6331]
		IRS NUMBER:				952583928
		STATE OF INCORPORATION:			NV
		FISCAL YEAR END:			1219

	FILING VALUES:
		FORM TYPE:		SC 13G
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	005-10808
		FILM NUMBER:		191106316

	BUSINESS ADDRESS:	
		STREET 1:		26050 MUREAU ROAD
		CITY:			CALABASAS
		STATE:			CA
		ZIP:			91302
		BUSINESS PHONE:		8185919800

	MAIL ADDRESS:	
		STREET 1:		26050 MUREAU ROAD
		CITY:			CALABASAS
		STATE:			CA
		ZIP:			91302

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	UNIVERSAL COVERAGE CORP
		DATE OF NAME CHANGE:	19730823

FILED BY:		

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			Roth William Harold
		CENTRAL INDEX KEY:			0001760878

	FILING VALUES:
		FORM TYPE:		SC 13G

	MAIL ADDRESS:	
		STREET 1:		216 NARCISSUS AVE.
		CITY:			CORONA DEL MAR
		STATE:			CA
		ZIP:			92625
SC 13G 1 roth_sc13g.htm

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

SCHEDULE 13G

 

Under the Securities Exchange Act of 1934

 

 

 

Unico American Corporation

 

(Name of Issuer)

 

Common Stock

 

(Title of Class of Securities)

 

904607108

 

(CUSIP Number)

 

September 18, 2019

 

(Date of Event Which Required Filing of this Statement)

 

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

 

☐  Rule 13d-1(b)

 

☒  Rule 13d-1(c)

 

☐  Rule 13d-1(d)

 

 

The information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

 

 

 

 

 

 

 

 

 

 

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 control number.

 

   
 

 

SCHEDULE 13G

 

CUSIP No. 904607108

 

         
1.   NAMES OF REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)

William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97
   
2.   CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
(see instructions)
(a)    ¨
(b)    ¨
   
3.   SEC USE ONLY
 
   
4.   CITIZENSHIP OR PLACE OF ORGANIZATION
 
United States
   

 

         
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH   5.   SOLE VOTING POWER
 
 
  6.   SHARED VOTING POWER
 
265,435
  7.   SOLE DISPOSITIVE POWER
 
 
  8.   SHARED DISPOSITIVE POWER
 
265,435

 

         
9.   AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON

265,435
   
10.   CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES
(see instructions)    ¨
   
11.   PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)

5.00%*
   
12.   TYPE OF REPORTING PERSON (see instructions)

IN
   

 

* Percentage ownership is based on 5,306,747 shares of Common Stock issued and outstanding as of August 14, 2019, as reported in the Issuer’s Form 10-Q for the fiscal quarter ended June 30, 2019.

 

 

 

 2 
 

 

CUSIP No. 904607108

 

         
1.   NAMES OF REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)

Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97
   
2.   CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
(see instructions)
(a)    ¨
(b)    ¨
   
3.   SEC USE ONLY
 
   
4.   CITIZENSHIP OR PLACE OF ORGANIZATION
 
United States
   

 

         
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH   5.   SOLE VOTING POWER
 
 
  6.   SHARED VOTING POWER
 
265,435
  7.   SOLE DISPOSITIVE POWER
 
 
  8.   SHARED DISPOSITIVE POWER
 
265,435

 

         
9.   AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON

265,435
   
10.   CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES
(see instructions)    ¨
   
11.   PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)

5.00%*
   
12.   TYPE OF REPORTING PERSON (see instructions)

IN
   

 

* Percentage ownership is based on 5,306,747 shares of Common Stock issued and outstanding as of August 14, 2019, as reported in the Issuer’s Form 10-Q for the fiscal quarter ended June 30, 2019.

 

 

 3 
 

 

CUSIP No. 904607108

 

Item 1.

 

  (a)

Name of Issuer

Unico American Corporation

     
  (b)

Address of Issuer’s Principal Executive Offices

26050 Mureau Road

Calabasas, California 91302

     

Item 2.

 

  (a)

Name of Person Filing

William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97

Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97

     
  (b)

Address of the Principal Office or, if none, residence

216 Narcissus Ave.

Corona del Mar, CA 92625

     
  (c)

Citizenship

William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – United States

Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – United States

     
  (d)

Title of Class of Securities

Common Stock

     
  (e)

CUSIP Number

904607108

     

 

Item 3.If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:

 

  (a) Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o).
       
  (b) Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c).
       
  (c) Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c).
       
  (d) Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8).
       
  (e) An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E);
       
  (f) An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);
       
  (g) A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G);
       
  (h) A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);
       
  (i) A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3);
       
  (j) Group, in accordance with §240.13d-1(b)(1)(ii)(J).
       

 

 

 

 4 
 

 

Item 4.Ownership.

 

Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1.

         
  (a)   Amount beneficially owned:
     

William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 265,435 shares

Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 265,435 shares

         
  (b)   Percent of class:  5.00%*
         
  (c)   Number of shares as to which the person has:
         
      (i) Sole power to vote or to direct the vote  
       

William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 0 shares

Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 0 shares

         
      (ii) Shared power to vote or to direct the vote  .
       

William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 265,435 shares

Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 265,435 shares

         
      (iii) Sole power to dispose or to direct the disposition of  .
       

William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 0 shares

 Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 0 shares

         
      (iv) Shared power to dispose or to direct the disposition of .
       

William Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 265,435 shares

Amy Roth, as Trustee of the William and Amy Roth Living Trust, dated 4/29/97 – 265,435 shares

 

* Percentage ownership is based on 5,306,747 shares of Common Stock issued and outstanding as of August 14, 2019, as reported in the Issuer’s Form 10-Q for the fiscal quarter ended June 30, 2019. Each of the Reporting Persons disclaims beneficial ownership of the shares reported herein except to the extent of its, his, or her pecuniary interest therein.

 

Item 5.Ownership of Five Percent or Less of a Class.

 

If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following ¨.

 

Item 6.Ownership of More than Five Percent on Behalf of Another Person.

 

Not applicable.

 

 

 

 

 

 5 
 

 

Item 7.Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company.

 

Not applicable.

 

Item 8.Identification and Classification of Members of the Group.

 

Not applicable.

 

Item 9.Notice of Dissolution of Group.

 

Not applicable.

 

Item 10.Certification.

 

By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.

 

Exhibit Document Description
   
99.1 Joint Filing Agreement

 

 

 

 

 6 
 

 

SIGNATURE

 

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

 

September 19, 2019

 

  By: /s/ William Roth
    William Roth, as trustee of the William and Amy Roth Living Trust, dated 4/29/97
     
  By: /s/ Amy Roth
    Amy Roth, as trustee of the William and Amy Roth Living Trust, dated 4/29/97

 

 

 

 

 

 

 

 

 7 

 

 

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