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
PSYCHIATRIC SOLUTIONS INC [ PSYS ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 10/20/2003 | ||||||||||||||||||||||||||
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 | 10/20/2003 | J(1) | 11,485 | D | $0.00(1) | 11,483 | I | See Footnote(2) | ||
Common Stock | 10/20/2003 | J(3) | 6,473 | D | $0.00(3) | 6,470 | I | See Footnote(4) | ||
Common Stock | 10/20/2003 | J(5) | 23,442 | D | $0.00(5) | 23,477 | I | See Footnote(6) | ||
Common Stock | 6,608 | I | See Footnote(7) | |||||||
Common Stock | 6,612 | I | See Footnote(8) |
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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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. On 10/20/03, CGJR II, L.P. ("CGJR II") made an in-kind pro rata distribution of shares of Common Stock to its general and limited partners. |
2. The securities are owned directly by CGJR II. |
3. On 10/20/03, CGJR/MF III, L.P. ("CGJR III") made an in-kind pro rata distribution of shares of Common Stock to its general and limited partners. |
4. The securities are owned directly by CGJR III. |
5. On 10/20/03, CGJR Health Care Services Private Equities, L.P. ("CGJR Health") made an in-kind pro rata distribution of shares of Common Stock to its general and limited partners. |
6. The securities are owned directly by CGJR Health. |
7. The securities are owned directly by CGJR Capital Management, Inc. ("CGJR Management") and 1,652 shares of such total shares were received as part of the distributions described in notes (1), (3) and (5). In previous reports filed jointly with the Reporting Persons, the entities making such distributions reported direct beneficial ownership of the respective shares and each of Christopher Grant, Jr. and CGJR Management reported indirect beneficial ownership of such shares. |
8. The securities are owned directly by Christopher Grant, Jr. and 1,653 shares of such total shares were received as part of the distribution described in note (5). In previous reports filed jointly with the Reporting Persons, CGJR Health reported direct beneficial ownership of such shares and each of Christopher Grant, Jr. and CGJR Management reported indirect beneficial ownership of such shares. |
Remarks: |
Salix Partners II ("Salix Partners") is the general partner of each of Salix Ventures II, L.P. and Salix Affiliates II, L.P. Each of Salix Donovan, LLC ("Salix Donovan"), Salix Ivy, LLC ("Salix Ivy"), Salix Pou, LLC ("Salix Pou"), David Ward, Christopher Grant, Jr., a director of the Issuer, and Martin R. Felsenthal is a general partner of Salix Partners. Each of Messrs. Ward, Grant and Felsenthal is a manager of each of Salix Donovan, Salix Ivy and Salix Pou. Christopher Grant, Jr. is the president of Salix Management Corp and the president of CGJR Management. CGJR Management is the general partner of each of CGJR II, CGJR III and CGJR Health. The transactions reported herein have been separately reported on a Form 4 by Christopher Grant, Jr., CGJR Management, CGJR II, CGJR III and CGJR Health. The Reporting Persons have jointly filed prior reports with Christopher Grant, Jr., CGJR Management, CGJR II, CGJR III and CGJR Health and may be deemed to be members of a "group" with such other entities. Each Reporting Person disclaims the existence of a "group" and disclaims beneficial ownership of the securities referred to in this report, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of any such securities for purposes of Section 16 or for any other purpose. Before the adoption of electronic filing requirements, these transactions would have been reported on one joint form filed by the Reporting Persons, Christopher Grant, Jr., CGJR Management, CGJR II, CGJR III and CGJR Health. However, the electronic system now limits the number of filing persons per form, and multiple joint forms are required here due to the number of filing persons. That is the only reason that the Reporting Persons are reflecting these transactions (in which they have no pecuniary interest) on this Form 4. |
/s/ Robert D. Ivy, as attorney-in-fact for Salix Ventures II, L.P. | 10/22/2003 | |
/s/ Robert D. Ivy, as attorney-in-fact for Salix Management Corp. | 10/22/2003 | |
/s/ Robert D. Ivy, as attorney-in-fact for Salix Partners II | 10/22/2003 | |
/s/ Robert D. Ivy, as attorney-in-fact for Salix Donovan LLC | 10/22/2003 | |
/s/ Robert D. Ivy, as attorney-in-fact for Salix Ivy LLC | 10/22/2003 | |
/s/ Robert D. Ivy, as attorney-in-fact for Salix Pou LLC | 10/22/2003 | |
/s/ Robert D. Ivy, as attorney-in-fact for Salix Affiliates II LP | 10/22/2003 | |
/s/ Robert D. Ivy, as attorney-in-fact for David Alan Ward | 10/22/2003 | |
/s/ Robert D. Ivy, as attorney-in-fact for Martin R. Felsenthal | 10/22/2003 | |
** 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. |