-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, HT9v9fxQ09+hhqZHopuLLvVPrAInPgIgGb2eBC2ygAkXKHB5P7MyMaG5p2HdYqE1 2II//ISsDjevzVnmjgTXvg== 0000912057-01-523308.txt : 20010711 0000912057-01-523308.hdr.sgml : 20010711 ACCESSION NUMBER: 0000912057-01-523308 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010630 FILED AS OF DATE: 20010710 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INSIGHT HEALTH SERVICES CORP CENTRAL INDEX KEY: 0001012697 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 330702770 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-28622 FILM NUMBER: 1678260 BUSINESS ADDRESS: STREET 1: 4400 MACARTHUR BLVD STREET 2: SUITE 800 CITY: NEWPORT BEACH STATE: CA ZIP: 92660 BUSINESS PHONE: 9494760733 MAIL ADDRESS: STREET 1: 4400 VON KARMAN AVE STE 800 CITY: NEWPORT BEACH STATE: CA ZIP: 92660 COMPANY DATA: COMPANY CONFORMED NAME: GENERAL ELECTRIC CO CENTRAL INDEX KEY: 0000040545 STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC & OTHER ELECTRICAL EQUIPMENT (NO COMPUTER EQUIP) [3600] OWNER IRS NUMBER: 140689340 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 3135 EASTON TURNPIKE STREET 2: W3M CITY: FAIRFIELD STATE: CT ZIP: 06431 BUSINESS PHONE: 203-373-2211 MAIL ADDRESS: STREET 1: 3135 EASTON TURNPIKE CITY: FAIRFIELD STATE: CT ZIP: 06431 4 1 a2053941z4.txt FORM 4
- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------------- FORM 4 WASHINGTON, D.C. 20549 OMB APPROVAL - -------- ----------------------------- / / CHECK THIS BOX IF NO STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0287 LONGER SUBJECT TO EXPIRES: DECEMBER 31, 2001 SECTION 16. FORM 4 OR Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN FORM 5 OBLIGATIONS MAY Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 0.5 CONTINUE. SEE Section 30(f) of the Investment Company Act of 1940 ----------------------------- INSTRUCTIONS 1(b). (Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name AND Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) General Electric Company InSight Health Services Corp. (IHSC) Director X 10% Owner ---- ---- - --------------------------------------------------------------------------------------------- Officer (give Other (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- title ---- (specify Number of Reporting Month/Year below) below Person (Voluntary) ----------------- ------------------ 3135 Easton Turnpike 14-0689340 06/01 - -------------------------------------------- --------------------- 7. Individual or Joint/Group Filing (Street) 5. If Amendment, (Check Applicable Line) Date of Original X Form filed by One Reporting Person (Month/Year) ___Form filed by More than One Fairfield Connecticut 06431 Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action or Disposed of (D) Securities ship of In- Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 8) Owned at Direct Bene- (Month/ End of (D) or ficial Day/ ------------------------------------------- Month Indirect Owner- Year) (A) or (I) ship Code V Amount (D) Price (Instr. 3 (Instr. 4) (Instr. 4) and 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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 (3-99) 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 1 OF 3
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 Security 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- 6. Date Exer- (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 (Month/ posed of (D) (Month/Day/ Deriv- Day/ (Instr. 3, 4, and 5) Year) ative Year) Security ------------------------- Date Expira- -------------------------------------- Exer- tion cisable Date Code V (A) (D) - ----------------------------------------------------------------------------------------------------------------------------- Series C Convertible None 6/25/01 J(1) 10,948 Immediately None Preferred Stock(1) - ----------------------------------------------------------------------------------------------------------------------------- Warrants(2) $10.00(3) 11/20/97 J(2) 15,000 Immediately(4) 11/20/07(5) - ----------------------------------------------------------------------------------------------------------------------------- Warrants(2) $8.875(3) 11/20/00 J(2) 5,000 Immediately(7) 11/20/10(5) - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------ 7. Title and Amount of Under- 8. Price 9. Number 10. Owner- 11. Nature lying Securities of of Deriv- ship of In- (Instr. 3 and 4) Deriv- ative Form direct ative Securi- of De- Bene- Secur- ties rivative ficial ity Bene- Secu- Own- (Instr. ficially rity: ership 5) Owned Direct (Instr. 4) at End (D) or Amount or of Indi- Title Number of Month rect (I) Shares (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------ Common Stock 1,307,224 See Note 1 17,005(1) D - ------------------------------------------------------------------------------------------ Common Stock 15,000(3) See Note 2 270,000(6) D - ------------------------------------------------------------------------------------------ Common Stock 5,000(3) See Note 2 270,000(6) D - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ Explanation of Responses: (1) Effective June 25, 2001, General Electric Company ("GE") transferred 10,948 of the 27,953 shares of InSight Health Services Corp. ("InSight") Series C Convertible Preferred Stock owned by it to GE Fund as a charitable donation. The Series C Convertible Preferred Stock is convertible into shares of the common stock, par value $.001 per share (the "Common Stock"), of InSight, and GE has retained a beneficial interest in 2,030,448 shares of Common Stock through its ownership of 17,005 shares of Series C Preferred Stock. Under its terms, the Series C Convertible Preferred Stock is also convertible, under certain conditions, into shares of Series D Convertible Preferred Stock. The Series D Convertible Preferred Stock, in turn, is also convertible into Common Stock. Both the 17,005 shares of Series C Convertible Preferred Stock and the shares of Series D Convertible Preferred Stock issuable upon conversion of such 17,005 shares of Series C Convertible Preferred Stock are convertible into 2,030,448 shares of Common Stock, subject to adjustment under certain circumstances. SEE ATTACHMENT 1 /s/ Eliza Fraser, Esq. July 10, 2001 ----------------------------------- ------------- **Intentional misstatements or omissions of facts constitute **Signature of Reporting Person Date Federal Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Eliza Fraser, Esq., Associate Corporate Counsel, Note: File three copies of this Form, one of which must be manually signed. on behalf of General Electric Company 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.
PAGE 2 OF 3 ATTACHMENT 1 NAME AND ADDRESS OF REPORTING PERSON: General Electric Company 3135 Easton Turnpike Fairfield, CT 06431 ISSUER NAME AND TICKER OR TRADING SYMBOL: InSight Health Services Corp. (IHSC) Statement on Form 4 for 06/01 (Continuation of footnotes to Table II) (2) GE has been granted the right ("Right"), by virtue of its ownership of (i) at least a majority of the Common Stock or the Series C Convertible Preferred Stock or (ii) a portion of the Series D Convertible Preferred Stock, to elect or appoint at least one member of InSight's Board of Directors (the "GE Director"). In connection with the Right and in consideration of GE's willingness to furnish the services of the GE Director, InSight has granted GE the following warrants: (i) warrants to purchase up to 15,000 shares of Common Stock at an exercise price of $10.00 per share (the "Initial GE Director Warrants"), and (ii) warrants to purchase up to 5,000 shares of Common Stock at an exercise price of $8.875 per share (the "Additional GE Director Warrants"). (3) The exercise price and the number of Common Shares purchasable upon the exercise of each Initial GE Director Warrant and each Additional GE Director Warrant are subject to adjustment under various circumstances. (4) The Initial GE Director Warrants vest cumulatively and are exercisable at the rate of 416.67 warrants each month commencing on November 20, 1997 until fully vested, so long as GE retains the Right. (5) The Initial GE Director Warrants and the Additional GE Director Warrants expire earlier if the Right is terminated, subject to GE's right until the expiration date to purchase from InSight the Common Stock issuable upon exercise of any warrants which vest prior to such termination. (6) In connection with a recapitalization consummated by InSight on October 14, 1997, GE acquired warrants to purchase up to 250,000 shares of Common Stock at an exercise price of $10.00 per share, subject to adjustment under various circumstances (the "Initial Warrants"). GE holds a total of 270,000 warrants to purchase Common Stock of InSight, comprised of the Initial Warrants, the Initial GE Director Warrants and the Additional GE Director Warrants. (7) The Additional GE Director Warrants vest cumulatively and are exercisable at the rate of 416.67 warrants each month commencing on November 20, 2000 until fully vested, so long as GE retains the Right. PAGE 3 OF 3 -----END PRIVACY-ENHANCED MESSAGE-----