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
SIRVA INC [ SIR ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 12/01/2003 | |||||||||||||||||||||||||
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 | ||||||
Common Stock, par value $0.01 per share | 12/01/2003 | S | 1,029,517 | D | $18.5 | 6,302,661 | D(1) | |||
Junior Exchangeable Preferred Stock | 12/01/2003 | J(2) | 24,500 | D | $32,633,009(2) | 0 | D | |||
Common Stock, par value $0.01 per share | 12/01/2003 | S | 1,029,517 | D | $18.5 | 6,302,661 | I(3) | See Footnote 3 | ||
Junior Exchangeable Preferred Stock | 12/01/2003 | J(2) | 24,500 | D | $32,633,009(2) | 0 | I(3) | See Footnote 3 | ||
Common Stock, par value $0.01 per share | 12/01/2003 | S | 1,029,517 | D | $18.5 | 6,302,661 | I(4) | See Footnote 4 | ||
Junior Exchangeable Preferred Stock | 12/01/2003 | J(2) | 24,500 | D | $32,633,009(2) | 0 | I(4) | See Footnote 4 | ||
Common Stock, par value $0.01 per share | 12/01/2003 | S | 1,029,517 | D | $18.5 | 6,302,661 | I(5) | See Footnote 5 | ||
Junior Exchangeable Preferred Stock | 12/01/2003 | J(2) | 24,500 | D | $32,633,009(2) | 0 | I(5) | See Footnote 5 | ||
Common Stock, par value $0.01 per share | 12/01/2003 | S | 1,029,517 | D | $18.5 | 6,302,661 | I(6) | See Footnote 6 | ||
Junior Exchangeable Preferred Stock | 12/01/2003 | J(2) | 24,500 | D | $32,633,009(2) | 0 | I(6) | See Footnote 6 | ||
Common Stock, par value $0.01 per share | 12/01/2003 | S | 1,029,517 | D | $18.5 | 6,302,661 | I(7) | See Footnote 7 | ||
Junior Exchangeable Preferred Stock | 12/01/2003 | J(2) | 24,500 | D | $32,633,009(2) | 0 | I(7) | See Footnote 7 |
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 |
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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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. Exel International Holdings (Netherlands 2) B.V. ("Holdings"), a group member, is a direct wholly-owned subsidiary of Exel International Holdings (Netherlands 1) B.V. ("Holdings1"), an indirect wholly-owned subsidiary of Realcause Ltd. ("Realcause"), an indirect wholly-owned subsidiary of Exel International Holdings Ltd. ("International"), an indirect wholly-owned subsidiary of Exel Investments Ltd. ("Investments") and an indirect wholly-owned subsidiary of Exel plc ("Exel"). Holdings owns directly 6,302,661 shares of Common Stock ("Common Stock"), par value $0.01 per share, of SIRVA, Inc. (the "Company"). |
2. The 24,500 shares of Junior Exchangeable Preferred Stock of the Company were called for redemption by the Company at a price equal to the liquidation preference of such securities of $1,000 per share plus net accrued and unpaid dividends of $8,133,009. |
3. Holdings1, a group member and direct wholly-owned subsidiary of Realcause, does not own directly, any shares of Common Stock of the Company. Holdings1 has an indirect beneficial ownership interest in 6,302,661 shares of Common Stock of the Company, owned by Holdings1's direct wholly-owned subsidiary Holdings. This report shall not be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 of the Securities Exchange Act of 1934 (the "Act") or for any other purpose. |
4. Realcause, a group member and direct wholly-owned subsidiary of International, does not own directly, any shares of Common Stock of the Company. Realcause has an indirect beneficial ownership interest in 6,302,661 shares of Common Stock of the Company, owned by Realcause's indirect wholly-owned subsidiary Holdings. This report shall not be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 of the Act or for any other purpose. |
5. International, a group member and direct wholly-owned subsidiary of Investments, does not own directly, any shares of Common Stock of the Company. International has an indirect beneficial ownership interest in 6,302,661 shares of Common Stock of the Company, owned by International's indirect wholly-owned subsidiary Holdings. This report shall not be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 of the Act or for any other purpose. |
6. Investments, a group member and direct wholly-owned subsidiary of Exel, does not own directly, any shares of Common Stock of the Company. Investments has an indirect beneficial ownership interest in 6,302,661 shares of Common Stock of the Company, owned by Investments's indirect wholly-owned subsidiary Holdings. This report shall not be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 of the Act or for any other purpose. |
7. Exel, a group member, does not own directly, any shares of Common Stock of the Company. Exel has an indirect beneficial ownership interest in 6,302,661 shares of Common Stock of the Company, owned by Exel's indirect wholly-owned subsidiary Holdings. This report shall not be an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 of the Act or for any other purpose. |
Signature: /s/ Douglas George Evans Name: Douglas George Evans by Power of Attorney | 12/03/2003 | |
Signature: /s/ Douglas George Evans Name: Douglas George Evans Title: Secretary | 12/03/2003 | |
Signature: /s/ Douglas George Evans Name: Douglas George Evans Title: Director | 12/03/2003 | |
Signature: /s/ Douglas George Evans Name: Douglas George Evans Title: Director | 12/03/2003 | |
Signature: /s/ Douglas George Evans Name: Douglas George Evans Title: Director | 12/03/2003 | |
Signature: /s/ Douglas George Evans Name: Douglas George Evans by Power of Attorney | 12/03/2003 | |
** 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. |