FORM 4 |
UNITED STATES 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 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
OMNI ENERGY SERVICES CORP [ OMNI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 11/12/2003 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Series A Convertible Preferred Stock(1) | 11/12/2003(1) | J(1) | 3,091 | D | $0 | 0 | D | |||
Series B Convertible Preferred Stock(1) | 11/12/2003(1) | J(1) | 3,234 | D | $0 | 0 | D |
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 (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Convertible Preferred Stock(2) | $2.25(4) | 11/12/2003(2) | J(2) | 3,091 | 11/12/2003 | (5) | Common Stock | 1,373,777(4) | $0 | 3,091 | D(3) | ||||
Series B Convertible Preferred Stock(2) | $3.75(4) | 11/12/2003(2) | J(2) | 3,234 | 11/12/2003 | (5) | Common Stock | 862,400(4) | $0 | 3,234 | D(3) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. Reported as a non-derivative security on Table I because of conditions to conversion. Now reported as a derivative security in Table II. |
2. Previously reported as a non-derivative security on Table I because of conditions to conversion. Conditions to conversion met pursuant to an agreement between the issuer and the holders of the Series A and B Convertible Preferred Stock on November 12, 2003 based on the level of the issuer's consolidated net income before interest, income taxes, depreciation, and amortization reflected in the issuer's earnings release issued November 6, 2003 for the quarter ended September 30, 2003. |
3. Owned directly by Advantage Capital Partners VI Limited Partnership and indirectly by Advantage Capital NOLA VI, L.L.C., its General Partner, and Steven T. Stull, the majority owner of its General Partner. Each indirect owner disclaims beneficial ownership of the securities included in this report, except to the extent of such owner's pecuniary interest therein. |
4. Adjusted to reflect a 1-for-3 reverse stock split effective July 3, 2002. |
5. None |
ADVANTAGE CAPITAL PARTNERS VI LIMITED PARTNERSHIP, by: Advantage Capital NOLA VI, L.L.C., its General Partner, by: Steven T. Stull, President | 11/14/2003 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** 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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |