-----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, AwwcTslhghm9aQQmAfaXsRhFCJXtJMOFcLPf+Wg6BtSe20hBjijBxfi+GU2KiuAS saIU7NIddtvHfQL0K4zc6A== 0000950123-01-504208.txt : 20010710 0000950123-01-504208.hdr.sgml : 20010710 ACCESSION NUMBER: 0000950123-01-504208 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010629 FILED AS OF DATE: 20010709 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: 3 SEC ACT: SEC FILE NUMBER: 000-28622 FILM NUMBER: 1677065 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: JW CHILDS EQUITY PARTNERS II LP CENTRAL INDEX KEY: 0001144473 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER IRS NUMBER: 043290201 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: ONE FEDERAL STREET CITY: BOSOTN STATE: MA ZIP: 02110 BUSINESS PHONE: 6177531100 MAIL ADDRESS: STREET 1: ONE FEDERAL STREET STREET 2: 21ST FLOOR CITY: BOSTON STATE: MA ZIP: 02110 3 1 y51302e3.txt FORM 3 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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 (Print or Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* J.W. Childs Equity Partners II, L.P. - -------------------------------------------------------------------------------- (Last) (First) (Middle) One Federal Street, 21st Floor - -------------------------------------------------------------------------------- (Street) Boston, MA 02110 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Date of Event Requiring Statement (Month/Day/Year) 6/29/01 ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) ________________________________________________________________________________ 4. Issuer Name and Ticker or Trading Symbol InSight Health Services Corp. (IHSC) ________________________________________________________________________________ 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) [_] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 6. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check Applicable Line) [_] Form filed by One Reporting Person [X] Form filed by More than One Reporting Person ================================================================================ TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $0.001 per 10,000 shares of I The common stock is owned by David W. share Common Stock Dupree, Managing Director of The Halifax Group, L.L.C., an affiliate of Halifax Capital Partners, L.P., one of the Reporting Persons. - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
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 5(b)(v). 2 FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ================================================================================
5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date --------------------------------- 4. Conver- Security: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Preferred Stock, $8.375 per Series B Common Stock 2,985,074.6 share (2) I (1) (1) - ------------------------------------------------------------------------------------------------------------------------------------ Preferred Stock, $8.375 per Series C Common Stock 3,337,672 share (2) I (1) (1) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) On June 29, 2001, InSight Health Services Holdings Corp., a Delaware corporation ("Holdings"), JWCH Merger Corp., a Delaware corporation and wholly owned subsidiary of Holdings ("Mergeco") and InSight Health Services Corp., a Delaware corporation (the "Company"), entered into an Agreement and Plan of Merger (the "Merger Agreement") providing for the proposed merger of Mergeco with and into the Company whereby the Company will become the wholly-owned subsidiary of Holdings. J.W. Childs Equity Partners II, L.P., a Delaware limited partnership ("J.W. Childs"), owns approximately 80% of the capital stock of Holdings and Halifax Capital Partners, L.P., a Delaware limited partnership ("Halifax"), owns approximately 20% of the capital stock of Holdings. This Form 3 is being jointly filed by J.W. Childs, Halifax, Holdings and Mergeco, which are hereinafter referred to as the "Reporting Persons". In connection with the Merger Agreement, Holdings and Mergeco entered into (i) that certain Voting Agreement (the "GE Voting Agreement"), dated June 29, 2001, among Holdings, MergeCo, and General Electric Company ("GE"), (ii) that certain Voting Agreement (the "GE Fund Voting Agreement"), dated June 29, 2001, among Holdings, MergeCo, and GE Fund ("GE Fund"), and (iii) that certain Voting Agreement (the "Carlyle Voting Agreement"), dated June 29, 2001, among Holdings, MergeCo, and Carlyle Partners II, L.P., a Delaware limited partnership, Carlyle Partners III, L.P., a Delaware limited partnership, Carlyle International Partners II, L.P., a Cayman Islands exempted limited partnership, Carlyle International Partners III, L.P., a Cayman Islands exempted limited partnership, C/S International Partners, a Cayman Islands general partnership, State Board of Administration of Florida, Carlyle Investment Group, L.P., a Delaware limited partnership, Carlyle-InSight International Partners, L.P., a Cayman Islands exempted limited partnership, Carlyle-InSight Partners, L.P., a Delaware limited partnership and TC Group, L.L.C., a Delaware limited liability company (together "Carlyle"), (the GE Voting Agreement, the GE Fund Voting Agreement and the Carlyle Voting Agreement are collectively referred to herein as the "Voting Agreements"). Based on representations made in the Voting Agreements: (x) Carlyle beneficially owns 25,000 shares of InSight Health Services Corp. (the "Company") convertible preferred stock, Series B, par value $0.001 per share ("Series B Preferred Stock"), convertible into 298,507.46 shares of the Company's convertible preferred stock, Series D, par value $0.001 ("Series D Preferred Stock") and ultimately convertible into 2,985,074.6 shares of the Company's common stock, par value $0.001 per share ("Common Stock") and warrants to purchase up to 290,000 shares of Common Stock, (y) GE beneficially owns 17,005 shares of the Company's convertible preferred stock, Series C, par value $0.001 per share ("Series C Preferred Stock"), convertible into 203,044.8 shares of the Company's Series D Preferred Stock and 3 FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ultimately convertible into 2,030,448 shares of the Company's Common Stock and warrants to purchase up to 270,000 shares of Common Stock and (z) GE Fund beneficially owns 10,948 shares of the Company's Series C Preferred Stock convertible into 130,722.4 shares of the Company's Series D Preferred Stock and ultimately convertible into 1,307,224 shares of the Company's Common Stock (Series B Preferred Stock, Series C Preferred Stock, Series D Preferred Stock, warrants beneficially owned by GE and Carlyle and all securities issued in respect of the foregoing are collectively referred to herein as the "Subject Shares"). Based on these representations and the representations of the Company in the Merger Agreement regarding the number of outstanding shares of Common Stock as of June 29, 2001, GE, GE Fund and Carlyle beneficially own approximately 67.74%, in the aggregate, of the outstanding shares of Common Stock. Pursuant to the Voting Agreements, GE, GE Fund and Carlyle agreed, among other things, to vote in favor of the transactions contemplated by the Merger Agreement. As a result of the foregoing transactions, the Reporting Persons and certain officers of the Company may be deemed to have formed a "group" for the purposes of Section 13(d)(3) of the Securities Exchange Act of 1934, as amended (the "Act"). Each of the Reporting Persons expressly declares that the filing of this Form 3 shall not be construed as an admission by it, for the purposes of the Act, that it has formed a group, that it is the beneficial owner of, or that it has any shared voting or dispositive power over, or pecuniary interest in, any shares of Common Stock. (2) Subject to customary anti-dilution adjustments. Other Reporting Persons: Halifax Capital Partners, L.P. InSight Health Services Holdings Corp. JWCH Merger Corp. 1133 Connecticut Avenue, N.W., Suite 700 c/o J.W. Childs Associates, L.P. c/o J.W. Childs Associates, L.P. Washington, DC 20036 One Federal Street, 21st Floor One Federal Street, 21st Floor Boston, MA 02110 Boston, MA 02110
** 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 sufficient, 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. 4 Filer: J.W. Childs Equity Partners II, L.P. One Federal Street, 21st Floor Boston, MA 02110 Date of Event Requiring Statement: 6/29/01 Issuer Name and Ticker or Trading Symbol: InSight Health Services Corp. (IHSC) J.W. CHILDS EQUITY PARTNERS II, L.P. By: J.W. Childs Advisors II, L.P., its General Partner By: J.W. Childs Associates, L.P., its General Partner By: J.W. Childs Associates, Inc., its General Partner By: /s/ Edward D. Yun ------------------------------------------ Name: Edward D. Yun ------------------------------------ Title: Vice President ------------------------------------ Additional Signatures: HALIFAX CAPITAL PARTNERS, L.P. By: Halifax Genpar, L.P. By: The Halifax Group, L.L.C. By: /s/ David W. Dupree ----------------------------------- Name: David W. Dupree Title: Managing Partner INSIGHT HEALTH SERVICES HOLDINGS CORP. By: /s/ Mark J. Tricolli ----------------------------------- Name: Mark J. Tricolli Title: Vice President JWCH MERGER CORP. By: /s/ Mark J. Tricolli ----------------------------------- Name: Mark J. Tricolli Title: Vice President -----END PRIVACY-ENHANCED MESSAGE-----