5 1 form5tmlong-gw.txt FORM 5 BROWN BROTHERS HARRIMAN/T. MICHAEL LONG ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0362 Expires: December 31, 2001 Estimated average burden hours per response........ 1.0 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 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 [_] 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 ________________________________________________________________________________ 1. Name and Address of Reporting Person* Long T. Michael -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Brown Brothers Harriman & Co. 59 Wall Street -------------------------------------------------------------------------------- (Street) New York NY 10005 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Genesee & Wyoming Inc. (GNWR) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year Year Ended 12/31/01 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [X] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check Applicable Line) [X] Form filed by One Reporting Person [_] Form filed by More than One Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. 6. 4. Amount of Owner- Securities Acquired (A) or Securities ship 2. 3. Disposed of (D) Beneficially Form: 7. Transaction Transaction (Instr. 3, 4 and 5) Owned at End Direct Nature of Date Code ------------------------------- of Issuer's (D) or Indirect 1. (Month/ (Instr. 8) (A) Fiscal Year Indirect Beneficial Title of Security Day/ ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) Year) Code (D) and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Common Stock, $.01 par value -0- (4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the form is filed by more than one reporting person, see Instruction 4(b)(v). 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. (Over) SEC 2270 (3/99) FORM 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- Securities Date Securities Price Bene- ity: In- cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Trans- of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ Class A Common Stock, Stock Option $.01 par (Right to Buy) $18.50 1/11/01 A 3,000(1) (1) 1/10/11 value 3,000(1) 3,000 (1) D ------------------------------------------------------------------------------------------------------------------------------------ Class A Common Stock, Phantom Stock 1,103.083 1,103.083 $.01 par 1,103.083 1,103.083 Units -0- (2) A (2) (2) (2) value (2) (2) D ------------------------------------------------------------------------------------------------------------------------------------ Series A Senior Redeemable Convertible Class A Participating Common Preferred Stock, Stock, par value $.01 par $.01 per share (3) Immediately N/A value (4) $1,000 25,000(4) I (5) ====================================================================================================================================
Explanation of Responses: (1) This option was granted under the Issuer's 1996 Stock Option Plan for Outside Directors in a transaction exempt under Rule 16b-3. The Reporting Person can exercise the option as follows: 1,000 shares on 1/11/02, 1,000 shares on 1/11/03, and 1,000 shares on 1/11/04. (2) These aggregated Phantom Stock Units were credited to the Reporting Person's account, on 3/1/01 at $17.917 per share, on 5/1/01 at $17.63 per share, on 6/1/01 at $17.63 per share, on 8/1/01 at $26.95 per share and on 11/1/01 at $26.95 per share, under the Issuer's Deferred Stock Plan for Non-Employee Directors in transactions exempt under Rule 16b-3. The Units are to be settled in the Issuer's Common Stock on a deferred basis pursuant to the Reporting Person's prior election. (3) $1,000 per share of Preferred Stock divided by the Conversion Price, set at $15.33, but subject to adjustment. (4) Convertible into 1,630,436 shares of Class A Common Stock, subject to adjustment. In addition, the Reporting Person may, pursuant to Rule 13d-3 of the Securities Exchange Act of 1934, as amended, be deemed to own certain shares of Class A Common Stock of Genesee & Wyoming Inc. owned by Mortimer B. Fuller, III as a result of a voting agreement. The Reporting Person disclaims beneficial ownership of such shares. (5) By the 1818 Fund III, L.P. (the "1818 Fund III"). The Reporting Person is a general partner of Brown Brothers Harriman & Co. ("BBH"), the general partner of the 1818 Fund III, and, as such, his pecuniary interest in the securities is limited to his percentage interest in BBH's interest in such securities. /s/ T. Michael Long February 13, 2002 --------------------------------------------- ----------------------- **Signature of Reporting Person Date T. Michael Long ** 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 control number. Page 2