4 1 a2100824z4.txt FORM 4
-------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------------- FORM 4 WASHINGTON, D.C. 20549 OMB APPROVAL -------- ----------------------------- / / Check this box if no STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0287 longer subject to Expires: January 31, 2005 Section 16. Form 4 or Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Estimated average burden Form 5 obligations may Section 17(a) of the Public Utility Holding Company Act of 1935 or hours per response .... 0.5 continue. SEE Section 30(h) of the Investment Company Act of 1940 ----------------------------- Instruction 1(b). (Print or Type Responses) ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name AND Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) X Director 10% Owner Harkins David V. Fisher Scientific International, Inc. (FSH) ---- ---- --------------------------------------------------------------------------------------------- Officer (give Other (Last) (First) (Middle) 3. I.R.S. Identification 4. Statement for ---- title ---- (specify Number of Reporting Month/Day/Year below) below) Person, if an entity c/o Thomas H. Lee Partners, L.P. (voluntary) 75 State Street 1/14/03 -------------------------------------------- --------------------- ------------------ ------------------------------------- (Street) 5. If Amendment, 7. Individual or Joint/Group Filing Date of Original (Check Applicable Line) (Month/Day/Year) _X_Form filed by One Reporting Person ___Form filed by More than One Boston MA 02109 Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of 2. Trans- 2A. Deemed 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature Security action Execution action or Disposed of (D) Securities ship of In- (Instr. 3) Date Date, Code (Instr. 3, 4 and 5) Beneficially Form: direct if any (Instr. 8) Owned Follow- Direct Bene- (Month/ (Month/ ing Reported (D) or ficial Day/ Day/ ------------------------------------------ Transaction(s) Indirect Owner- Year) Year) (A) or (Instr. 3 (I) ship Code V Amount (D) Price and 4) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.01 per share 1/14/03 J(1) 5,402,662 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.01 per share 1/14/03 J(1) 5,062 A(2) 5,982,068 I See Note 1 ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.01 per share 11/21/02 G V 10,000 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.01 per share 1/14/03 J(1) 57,756 A(3) 157,285 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.01 per share 1/14/03 J(1) 10,044 A(4) 24,601 I See Note 5 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative Security 2. Conver- 3. Trans- 3A. Deemed 4. Transac- 5. Number of Deriv- 6. Date Exer- (Instr. 3) sion or action Execution tion Code ative Securities Ac- cisable and Ex- Exercise Date Date, (Instr. 8) quired (A) or Dis- piration Date Price of (Month/ if any posed of (D) (Month/Day/ Deriv- Day/ (Month/ (Instr. 3, 4, and 5) Year) ative Year) Day/ Security Year) -------------------------------------- ---------------- Date Expira- Exer- tion Code V (A) (D) cisable Date ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- 7. Title and Amount of 8. Price of 9. Number of 10. Ownership 11. Nature of Underlying Securities Derivative Derivative Form of Indirect (Instr. 3 and 4) Security Securities Derivative Beneficial (Instr. 5) Beneficially Securities: Ownership Owned Direct (D) or (Instr. 4) Following Indirect (I) Reported (Instr. 4) Transaction(s) ----------------------- (Instr. 4) Title Amount or Number of Shares ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- Explanation of Responses: (1) The reporting person is a Trustee of THL Equity Trust III ("Equity Trust III"), which, in turn, is the General Partner of Thomas H. Lee Equity Advisors III Limited Partnership ("Equity Advisors III"), which, in turn, is the General Partner of Thomas H. Lee Equity Fund III, L.P. ("Equity Fund III"), THL FSI Equity Investors, L.P. ("FSI") and Thomas H. Lee Foreign Fund III, L.P. ("Foreign Fund III"). The reporting person may be deemed to beneficially own the shares of the Issuer held directly by Equity Trust III, Equity Fund III, FSI, and Foreign Fund III. On January 14, 2003 Equity Fund III, Foreign Fund III, FSI, and Equity Advisors III issued a pro rata distribution of common stock of the Issuer to their respective general and limited partners. The reporting person disclaims beneficial ownership of such shares, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for the purpose of Section 16 or for any other purpose, except to the extent of its pecuniary interest therein. (2) Represents shares distributed to Equity Trust III in connection with the distribution described in footnote (1) above. (3) Represents shares distributed to the reporting person in connection with the distribution described in footnote (1) above. (4) Represents shares distributed to the 1995 Harkins Gift Trust in connection with the distribution described in footnote (1) above. (5) Represents shares held directly by the 1995 Harkins Gift Trust, which may be deemed indirectly beneficially owned by the reporting person. The reporting person disclaims beneficial ownership of such shares, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for the purpose of Section 16 or for any other purpose, except to the extent of its pecuniary interest therein. /s/ David V. Harkins 1/15/03 ----------------------------------- ----------- **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.