5 1 form5.txt FORM 5 (ROBERTS, GEORGE R.) OMB APPROVAL ------------ OMB Number 3235-0362 Expires: January 31, 2005 Estimated average burden hours per response... 1.0 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 5 ANNUAL 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 [_] Check if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [_] Form 3 Holdings Reported [_] Form 4 Transactions Reported ________________________________________________________________________________ 1. Name and Address of Reporting Person Roberts, George R. -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Kohlberg Kravis Roberts & Co. 9 West 57th Street, Suite 4200 -------------------------------------------------------------------------------- (Street) New York, NY 10019 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol DPL Inc. (DPL) ________________________________________________________________________________ 3. IRS or Social Security Number of Reporting Person, if an entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year December 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [_] Officer [_] Other (give title below) (specify below) ________________________________________________________________________________ 7. Individual or Joint/Group Reporting (Check applicable line) [X] Form Filed by One Reporting Person [_] Form Filed by More than One Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. 6. 4. Amount of Owner- 2A. Securities Acquired (A) or Securities ship Deemed Disposed of (D) Beneficially Form: 7. Execution (Instr. 3, 4 and 5) Owned at End Direct Nature of 2. Date, if 3. ----------------------------- of Issuer's (D) or Indirect 1. Transaction any Transaction (A) Fiscal Year Indirect Beneficial Title of Security Date (Month/ Code Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (Month/Day/Year) Day/Year) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4) -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- ================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 1 of 3 FORM 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
9. 10. Number Owner- of ship 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- Securities Date Securities Price Bene- ity: In- cise 3. 3A. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- Deemed 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Execution Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date Date, if action (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ any (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship Security Secur- Day/ Day/ (Instr. ----------- Exer- tion of (Instr. (Instr. (Instr. (Instr (Instr. 3) ity Year) Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ Restricted Common Share Units 1-for-1 7/1/02 A(1) 1,500 (1) (1) Shares 1,500 $26.25 5,041.103(2) (I) (3) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) Deferral of directors fees into restricted share units representing DPL Inc. common shares pursuant to The Dayton Power & Light Company Directors Deferred Compensation Plan. Restricted share units are payable in shares of DPL Inc. common stock on a 1-for-1 basis upon the Reporting Person ceasing to be a director of DPL Inc. (2) Includes dividend equivalents credited on restricted share units. (3) Directors Deferred Compensation Plan. /s/ William J. Janetschek February 14, 2003 --------------------------------------------- ----------------------- **Signature of Reporting Person Date William J. Janetschek as attorney-in-fact for George R. Roberts ** Intentional misstatements or omissions of facts constitute Federal 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. Page 2 of 3 POWER OF ATTORNEY Know all men by these presents that George R. Roberts does hereby make, constitute and appoint William J. Janetschek and Richard J. Kreider, or either one of them, as a true and lawful attorney-in-fact of the undersigned with full powers of substitution and revocation, for and in the name, place and stead of the undersigned (both in the undersigned's individual capacity and as a member of any limited liability company or limited partnership for which the undersigned is otherwise authorized to sign), to execute and deliver such forms as may be required to be filed from time to time with the Securities and Exchange Commission with respect to any investments of KKR Associates, L.P., KKR Associates 1996 L.P., KKR 1996 GP L.L.C., KKR Associates II (1996) Limited Partnership, KKR 1996 Overseas, Limited, KKR Associates (Strata) L.P., Strata L.L.C., KKR Associates (KLC) L.P., KKR-KLC, L.L.C., KKR Associates (NXS) L.P., KKR-NXS, L.L.C., KKR Associates Europe, Limited Partnership, KKR Europe Limited, KKR Associates Millenium L.P. and KKR Millennium GP LLC (including any amendments or supplements to any reports, forms or schedules previously filed by such persons or entities): (i) pursuant to Section 13(d) and 16(a) of the Securities Exchange Act of 1934, as amended (the "Act"), including without limitation, Schedule 13D, Schedule 14G, statements on Form 3, Form 4 and Form 5 and (ii) in connection with any applications for EDGAR access codes, including without limitation the Form ID. /s/ George R. Roberts ---------------------------------- Name: George R. Roberts Date: February 28, 2002 Page 3 of 3