-----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, HPHh/uX9Gx33am82A2V5sOXLtXTvCFWUTHBkSWLhg120xvynh2Sfh7bdMIaOWndk EeBId/k71rmonIoGGXFBAw== 0000950116-99-002210.txt : 19991125 0000950116-99-002210.hdr.sgml : 19991125 ACCESSION NUMBER: 0000950116-99-002210 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991115 FILED AS OF DATE: 19991124 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: GENESIS HEALTH VENTURES INC /PA CENTRAL INDEX KEY: 0000874265 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 061132947 STATE OF INCORPORATION: PA FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 001-11666 FILM NUMBER: 99764478 BUSINESS ADDRESS: STREET 1: 101 EAST STATE STREET CITY: KENNETT SQUARE STATE: PA ZIP: 19348 BUSINESS PHONE: 6104446350 MAIL ADDRESS: STREET 1: 101 EAST STATE STREET CITY: KENNETT SQUARE STATE: PA ZIP: 19348 COMPANY DATA: COMPANY CONFORMED NAME: TPG ADVISORS II INC CENTRAL INDEX KEY: 0001075944 STANDARD INDUSTRIAL CLASSIFICATION: [] OTHER IRS NUMBER: 752695490 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 201 MAIN STREET STREET 2: STE 2420 CITY: FORT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: 8178714000 MAIL ADDRESS: STREET 1: 201 MAIN STREET STREET 2: STE 2420 CITY: FORT WORTH STATE: TX ZIP: 76102 3 1 - ------ ------------------------------------ FORM 3 OMB APPROVAL - ------ ------------------------------------ OMB Number: 3235-0104 Expires: December 31, 2001 Estimated average burden hours per response .............0.5 ------------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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* TPG Advisors II, Inc. -------------------------------------------------------------------- (Last) (First) (MI) 201 Main Street, Suite 2420 -------------------------------------------------------------------- (Street) Fort Worth, TX 76102 -------------------------------------------------------------------- (City) (State) (Zip) 2. Date of Event Requiring Statement (Month/Day/Year) 11/15/99 - ------------------------------------------------------------------------------- 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) - ------------------------------------------------------------------------------- 4. Issuer Name and Ticker or Trading Symbol Genesis Health Ventures, Inc. (GHV) - ------------------------------------------------------------------------------- 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] Director [ X ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) --------------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) - ------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person --- Form filed by More than One Reporting Person --- TABLE I - Non-Derivative Securities Beneficially Owned - -------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security | 2. Amount of Securities | 3. Ownership Form: | 4. Nature of Indirect Beneficial (Instr. 4) | Beneficially Owned | Direct (D) or Indirect | Ownership (Instr. 5) | (Instr. 4) | (I) (Instr. 5) | - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $0.02 | 6,250,000 shares | I | Through investment funds managed by per share ("Common Stock") | | | Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - -----------------------------------------------------------------------------------------------------------------------------------
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 5(b)(v). Potential persons who are to respond to the collection of Information contained in this form are not required to respond unless the form displays a currently valid OMB control number. (Over)
FORM 3 (continued) Table II -- Derivative Securities Benefically Owned (e.g., puts, calls, warrants, options, convertible securities) - --------------------------------------------------------------------------------------------- 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date | (Month/Day/Year) |----------------------------------------- | Date Exercisable | Expiration Date - --------------------------------------------------------------------------------------------- | | Warrants | Issue Date | 11/14/2009 | | - --------------------------------------------------------------------------------------------- | | Series H Senior Convertible Participating | Issue Date | None Cumulative Preferred Stock | | - --------------------------------------------------------------------------------------------- | | Series 1 Senior Convertible Participating | Issue Date | None Cumulative Preferred Stock | | - --------------------------------------------------------------------------------------------- | | | | | | ============================================================================================= =================================================================================================================================== 3. Title and Amount of Securities | 4. Conversion or Exercise | 5. Ownership Form of Derivative | 6. Nature of Indirect Underlying Derivative Security | Price of Derivative | Security: Direct (D) or | Beneficial Ownership (Instr. 4) | Security | Indirect (I) (Instr. 5) | (Instr. 5) - -----------------------------------------| | | | Amount or | | | | Number of | | | Title | Shares | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | | Through investment Common Stock | 1,000,000 | $5.00 | I | funds managed by | | | | Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- | | | | Through investment Common Stock | 13,228,604 | $8.75 | I | funds managed by | | | | Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- Non Voting Common | | | | Through investment Stock, par value | 9,571,452 | $8.75 | I | funds managed by $0.02 per share | | | | Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- | | | | | | | | | | | | - ----------------------------------------------------------------------------------------------------------------------------------- Explanation of Responses:
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. TPG ADVISORS II, INC. /s/ Richard A. Ekleberry November 24, 1999 ------------------------------- ----------------- **Signature of Reporting Person Date By: Richard A. Ekleberry Vice President Page 2 -----END PRIVACY-ENHANCED MESSAGE-----