0001058217-01-500161.txt : 20011008 0001058217-01-500161.hdr.sgml : 20011008 ACCESSION NUMBER: 0001058217-01-500161 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010831 FILED AS OF DATE: 20010917 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INSURANCE AUTO AUCTIONS INC /CA CENTRAL INDEX KEY: 0000880026 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-MOTOR VEHICLES & MOTOR VEHICLE PARTS & SUPPLIES [5010] IRS NUMBER: 953790111 STATE OF INCORPORATION: IL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19594 FILM NUMBER: 1739084 BUSINESS ADDRESS: STREET 1: 850 E ALGONQUIN RD STREET 2: STE 100 CITY: SCHAUMGURG STATE: IL ZIP: 60173 BUSINESS PHONE: 8478393939 MAIL ADDRESS: STREET 1: 850 E ALGONQUIN RD STREET 2: STE 100 CITY: SCHAUMGURG STATE: IL ZIP: 60173 COMPANY DATA: COMPANY CONFORMED NAME: UBBEN JEFFREY W CENTRAL INDEX KEY: 0001159187 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER IRS NUMBER: 355543560 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: ONE MANITIME PLAZA, SUITE 1400 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 4153623700 MAIL ADDRESS: STREET 1: ONE MANITIME PLAZA, SUITE 1400 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 4 1 ubben4form20497.txt FORM 4 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 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 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* Ubben Jeffrey W. -------------------------------------------------------------------------------- (Last) (First) (Middle) VA Partners, LLC, One Maritime Plaza, Suite 1400 -------------------------------------------------------------------------------- (Street) San Francisco CA 94111 -------------------------------------------------------------------------------- (City) (State) (Zip) IAAI - Insurance Auto Auctions, Inc -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) August, 2001 -------------------------------------------------------------------------------- 4. Statement for Month/Year -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [_] Form filed by one Reporting Person [X] Form filed by more than one Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) (Over) (Form 4-07/99) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 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- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Director Stock $14.30 *6/29/01 A 2,000 (1) 6/29/11 Common 2,000 D Option Stock (right to buy) ------------------------------------------------------------------------------------------------------------------------------------ Director Stock $14.30 *6/29/01 J(2) 2,000 (1) 6/29/11 Common 2,000 I3 (3)By ValueAct Option Stock Capital (right to buy) Partners, L.P. ------------------------------------------------------------------------------------------------------------------------------------ Director Stock $13.13 *2/15/01 J2 10,000 2/15/11 Common 10,000 12,000 I3 (3)By ValueAct Option Stock Capital (right to buy) Partners, L.P. ==================================================================================================================================== *Date of original grant of options to Jeffrey W. Ubben, which options were transferred effective in August 2001.
Explanation of Responses: (1) Options granted under 1991 Stock Option Plan, as amended. The options to buy shares of Insurance Auto Auctions, Inc. will become exercisable in 25% increments on 9/30/01, 12/31/01, 3/31/02 and 6/30/02. (2) Jeffrey W. Ubben transferred the reported options to ValueAct Capital Partners, L.P. (3) The Reported Options are owned directly by ValueAct Capital Partners, L.P. and indirectly by VA Partners, LLC as general partner of ValueAct Capital Partners, L.P. Peter Kamin and Jeffrey W. Ubben are directors of Insurance Auto Auctions, Inc. and Managing Members of VA Partners, LLC, the General Partner of ValueAct Capital Partners, L.P. George F. Hamel, Jr. is a Managing Member of VA Partners, LLC, the General Partner of ValueAct Capital Partners, L.P. The reporting persons disclaim beneficial ownership of the reported option except to the extent of his pecuniary interest therein. /S/ George F. Hamel, Jr. 9/14/01 --------------------------------------------- ----------------------- **Signature of Reporting Person Date George F. Hamel, Jr. Managing Member of VA Partners, LLC /S/ Jeffrey W. Ubben 9/14/01 --------------------------------------------- ----------------------- **Signature of Reporting Person Date Jeffrey W. Ubben /S/ George F. Hamel, Jr. 9/14/01 --------------------------------------------- ----------------------- **Signature of Reporting Person Date George F. Hamel, Jr. /S/ Peter H. Kamin 9/14/01 --------------------------------------------- ----------------------- **Signature of Reporting Person Date Peter F. Kamin ** 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 provided is insufficient, see Instruction 6 for procedure. Page 2