-----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, KN6o9O/8g6v7FnwYiTbVlqISb3l/j72hhcQPocd5E5U4AF93J9u1bdciduoOYVpL 9HibnZ6MicXSYNja3wWY/Q== 0000950123-01-508319.txt : 20020410 0000950123-01-508319.hdr.sgml : 20020410 ACCESSION NUMBER: 0000950123-01-508319 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20011017 FILED AS OF DATE: 20011113 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: 1934 Act SEC FILE NUMBER: 000-28622 FILM NUMBER: 1783702 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: 4 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 4 1 y54859be4.txt FORM 4 =============================================================================== | FORM 4 | U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 [_] CHECK THIS BOX IF NO LONGER SUBJECT TO SECTION 16. FORM 4 OR FORM 5 OBLIGATIONS MAY CONTINUE. SEE INSTRUCTION 1(b). 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 (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. ISSUER NAME AND TICKER OR TRADING SYMBOL INSIGHT HEALTH SERVICES CORP. (IHSC) ----------------------------------- 3. I.R.S. IDENTIFICATION NUMBER OF REPORTING PERSON, IF AN ENTITY (VOLUNTARY) -------------- 4. STATEMENT FOR MONTH/YEAR OCTOBER 2001 --------------------------------------------------- 5. IF AMENDMENT, DATE OF ORIGINAL (MONTH/YEAR) --------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director Officer [X] 10% Owner Other --- --- --- --- (give title below) (specify below) 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 Acquired, Disposed of, or Beneficially Owned
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Title 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature of action action or Disposed of (D) Securities ship of In- Security Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 3) (Month/ (Instr. 8) Owned at Direct Bene- Day/ ----------------------------------------------- End of (D) or ficial Year) Month Indirect Owner- Code V Amount (A) or Price (Instr. 3 and 4) (I) ship (D) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 10/17/01 P 1 share A See Footnote 1 1 Share D See Footnote 1 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 10/17/01 P 1 share A See Footnote 1 1 Share I See Footnote 2 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
This Statement of Changes in Beneficial Ownership (this "Statement") is being jointly filed by J. W. Childs Equity Partners II, L.P. ("J.W. Childs"), Halifax Capital Partners, L.P. ("Halifax") and InSight Health Services Holdings Corp. ("Holdings"), which are hereinafter collectively referred to as the "Reporting Persons." (1) Holdings is the direct beneficial owner of the sole outstanding share of Common Stock (as defined below) by virtue of the Merger (as defined below). On October 17, 2001, all of the outstanding common stock (the "Common Stock"), of InSight Health Services Corp. (the "Company") were acquired by Holdings. The acquisition was consummated by merging (the "Merger") InSight Health Services Acquisition Corp. ("Acquisition Corp."), a wholly-owned subsidiary of Holdings, with and into the Company whereby the Company became the wholly-owned subsidiary of Holdings pursuant to an Agreement and Plan of Merger, dated as of June 29, 2001, as amended, by and among the Company, Acquisition Corp. and Holdings (the "Merger Agreement"). Pursuant to the Merger Agreement, as a result of the Merger (i) each outstanding share of Common Stock was cancelled, retired and converted into the right to receive $18.00 in cash, (ii) each outstanding option and warrant to purchase Common Stock was canceled and converted into the right to receive the difference between $18.00 and the exercise price of such option or warrant, and (iii) the sole outstanding share of Acquisition Corp. was converted into one share of Common Stock of the Company, the surviving corporation. The total consideration paid to the holders of outstanding Common Stock and to the holders of outstanding options and warrants to purchase Common Stock was approximately $187.7 million. As of the close of business on October 17, 2001 the Common Stock was voluntarily delisted from the NASDAQ National Market. In addition, On October 17, 2001 the Company filed with the Securities and Exchange Commission a Certification and Notice of Termination of Registration under Section 12(g) of the Exchange Act on Form 15. Pursuant to Rule 12g-4 of the Exchange Act, termination of registration of the Common Stock shall take place no more than 90 days after the filing of the Form 15. (2) J.W. Childs and Halifax are indirect beneficial owners of the sole outstanding share of Common Stock. As a result of the Merger and related transactions: (i) Holdings beneficially and directly owns the sole outstanding share of Common Stock, (ii) J.W. Childs beneficially owns 4,350,290 shares or approximately 80% of the common stock of Holdings, including 4,011,758 shares of Holdings' common stock owned directly by J.W. Childs and 338,532 shares of Holdings' common stock owned directly by JWC InSight Co-invest, LLC, an affiliate of J.W. Childs, and (iii) Halifax beneficially owns 1,111,112 shares or approximately 20% of the common stock of Holdings including 1,107,020 shares of Holdings' common stock owned directly by Halifax and 4,092 shares of Holdings' common stock owned directly by David W. Dupree, a Managing Director of Halifax. Acquisition Corp. ceased to be a beneficial owner of any shares of Common Stock on October 17, 2001. On such date as a result of the Merger, Acquisition Corp. was merged out of existence. Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
- ----------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- Security (Instr. 3) sion or action tion Code ative Securities Exercise Date (Instr. 8) Acquired (A) or Price of (Month/ Disposed of (D) Deriv- Day/ (Instr. 3, 4, and 5) ative Year) Security -------------------------------------------------- Code V (A) (D) - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------
Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
- ------------------------------------------------------------------------------------------------------------------------------------ 6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na- cisable and Underlying Securities of of Deriv- ship ture Expiration (Instr. 3 and 4) Deriv- ative Form of In- Date ative Secur- of De- direct (Month/Day/ Secur- ities rivative Bene- Year) ity Bene- Securities ficial (Instr. ficially Bene- Owner- -------------------------------------------- 5) Owned ficially ship Date Expira- Amount or at End Owned at (Instr. Exer- tion Title Number of of End of 4) cisable Date Shares Month Month(1) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
The Reporting Persons and certain officers of the Company may be deemed to have formed a "group" for purposes of Section 13(d)(3) of the Securities and Exchange Act of 1934, as amended (the "Exchange Act"). Each of the Reporting Persons expressly declares that the filing of this Statement shall not be construed as an admission by it, for purposes of the Exchange Act, that it has formed a group or, with the exception of Holdings, that it is the beneficial owner of, or that it has any shared voting or dispositive power over the sole outstanding share of the Common Stock. Names and Addresses of Reporting Persons: J. W. Childs Equity Partners II, L.P. One Federal Street, 21st Floor Boston, MA 02110 Halifax Capital Partners, L.P. 1133 Connecticut Avenue, N.W., Suite 700 Washington, DC 20036 InSight Health Services Holdings Corp. c/o J.W. Childs Associates, L.P. One Federal Street, 21st Floor Boston, MA 02110 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 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: Vice President INSIGHT HEALTH SERVICES HOLDINGS CORP. By: /s/ Edward D. Yun ----------------------------------- Name: Edward D. Yun Title: President ** 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. -----END PRIVACY-ENHANCED MESSAGE-----