0000904454-17-000221.txt : 20170308
0000904454-17-000221.hdr.sgml : 20170308
20170308121435
ACCESSION NUMBER: 0000904454-17-000221
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170308
FILED AS OF DATE: 20170308
DATE AS OF CHANGE: 20170308
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: K2M GROUP HOLDINGS, INC.
CENTRAL INDEX KEY: 0001499807
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 272977810
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 600 HOPE PARKWAY SE
CITY: LEESBURG
STATE: VA
ZIP: 20175
BUSINESS PHONE: 703-777-3155
MAIL ADDRESS:
STREET 1: 600 HOPE PARKWAY SE
CITY: LEESBURG
STATE: VA
ZIP: 20175
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Scully Thomas
CENTRAL INDEX KEY: 0001414384
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36443
FILM NUMBER: 17674440
MAIL ADDRESS:
STREET 1: 320 PARK AVENUE, SUITE # 2500
CITY: NEW YORK
STATE: NM
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: RATHER JONATHAN M
CENTRAL INDEX KEY: 0001212994
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36443
FILM NUMBER: 17674441
MAIL ADDRESS:
STREET 1: 320 PARK AVENUE STE 2500
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MACKESY D SCOTT
CENTRAL INDEX KEY: 0001212997
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36443
FILM NUMBER: 17674442
MAIL ADDRESS:
STREET 1: 320 PARK AVENUE STE 2500
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DENICOLA ANTHONY J
CENTRAL INDEX KEY: 0001212992
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36443
FILM NUMBER: 17674443
MAIL ADDRESS:
STREET 1: 320 PARK AVENUE STE 2500
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CARSON RUSSELL L
CENTRAL INDEX KEY: 0001212986
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36443
FILM NUMBER: 17674445
MAIL ADDRESS:
STREET 1: 320 PARK AVENUE STE 2500
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Welsh, Carson, Anderson & Stowe XI, L.P.
CENTRAL INDEX KEY: 0001437914
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36443
FILM NUMBER: 17674447
BUSINESS ADDRESS:
STREET 1: C/O WELSH, CARSON, ANDERSON & STOWE
STREET 2: 320 PARK AVENUE, SUITE 2500
CITY: NEW YORK
STATE: NY
ZIP: 10022
BUSINESS PHONE: 212-893-9500
MAIL ADDRESS:
STREET 1: C/O WELSH, CARSON, ANDERSON & STOWE
STREET 2: 320 PARK AVENUE, SUITE 2500
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WELSH PATRICK J
CENTRAL INDEX KEY: 0001212985
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36443
FILM NUMBER: 17674446
MAIL ADDRESS:
STREET 1: 320 PARK AVENUE STE 2500
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ANDERSON BRUCE K
CENTRAL INDEX KEY: 0001212987
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36443
FILM NUMBER: 17674444
MAIL ADDRESS:
STREET 1: 320 PARK AVENUE STE 2500
CITY: NEW YORK
STATE: NY
ZIP: 10022
4
1
edgar.xml
PRIMARY DOCUMENT
X0306
4
2017-03-08
1
0001499807
K2M GROUP HOLDINGS, INC.
KTWO
0001437914
Welsh, Carson, Anderson & Stowe XI, L.P.
C/O WELSH, CARSON, ANDERSON & STOWE
320 PARK AVENUE, SUITE 2500
NEW YORK
NY
10022
0
0
1
0
0001212985
WELSH PATRICK J
C/O WELSH, CARSON, ANDERSON & STOWE
320 PARK AVENUE, SUITE 2500
NEW YORK
NY
10022
0
0
1
0
0001212986
CARSON RUSSELL L
C/O WELSH, CARSON, ANDERSON & STOWE
320 PARK AVENUE, SUITE 2500
NEW YORK
NY
10022
0
0
1
0
0001212987
ANDERSON BRUCE K
C/O WELSH, CARSON, ANDERSON & STOWE
320 PARK AVENUE, SUITE 2500
NEW YORK
NY
10022
0
0
1
0
0001212992
DENICOLA ANTHONY J
C/O WELSH, CARSON, ANDERSON & STOWE
320 PARK AVENUE, SUITE 2500
NEW YORK
NY
10022
0
0
1
0
0001212997
MACKESY D SCOTT
C/O WELSH, CARSON, ANDERSON & STOWE
320 PARK AVENUE, SUITE 2500
NEW YORK
NY
10022
0
0
1
0
0001212994
RATHER JONATHAN M
C/O WELSH, CARSON, ANDERSON & STOWE
320 PARK AVENUE, SUITE 2500
NEW YORK
NY
10022
0
0
1
0
0001414384
Scully Thomas
C/O WELSH, CARSON, ANDERSON & STOWE
320 PARK AVENUE, SUITE 2500
NEW YORK
NY
10022
0
0
1
0
Common Stock
2017-03-08
4
J
0
5384858
0
D
0
D
Distribution-in-kind of shares by the designated Reporting Person pro rata to its partners, including 10,023 shares to WCAS XI Associates LLC, the sole general partner of the designated Reporting Person. WCAS XI Associates LLC will further distribute such 10,023 shares to its members, including the Reporting Owners listed below.
The securities reported as directly beneficially owned by the designated Reporting Person may be deemed to be indirectly beneficially owned by each of the Reporting Owners listed below, each of whom is a managing member of WCAS XI Associates LLC, the sole general partner of the designated Reporting Person. Pursuant to Instruction 4(b)(iv) of Form 4, each such individual has elected to report as indirectly beneficially owned the entire number of securities owned by the designated Reporting Person, however each of them disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him.
Each Reporting Owner listed below may also be deemed to have indirectly beneficially owned 386,851 shares of Common Stock held by WCAS XI Co-Investors LLC (including 368,704 shares received in the distribution from the designated Reporting Person), which on March 8, 2017 were distributed-in-kind by WCAS XI Co-Investors LLC pro rata to to its members, including the Reporting Owners listed below. Pursuant to Instruction 4(b)(iv) of Form 4, each such individual has elected to report as indirectly beneficially owned the entire number of securities owned by WCAS XI Co-Investors LLC, however each of them disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him.
Part 1 of 2
/s/ David Mintz, Attorney-in-Fact
2017-03-08