-----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, LXBABkv1bQ3NjXyh99oo5SOphU/NbSBiFOk79T/NfXcfrz5gu2A1d8t4PsxFYxZX JvRhCOZBIZ6j45c3HES3gw== 0001047469-03-001457.txt : 20030115 0001047469-03-001457.hdr.sgml : 20030115 20030115131741 ACCESSION NUMBER: 0001047469-03-001457 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030114 FILED AS OF DATE: 20030115 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FISHER SCIENTIFIC INTERNATIONAL INC CENTRAL INDEX KEY: 0000880430 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-PROFESSIONAL & COMMERCIAL EQUIPMENT & SUPPLIES [5040] IRS NUMBER: 020451017 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-10920 FILM NUMBER: 03514636 BUSINESS ADDRESS: STREET 1: LIBERTY LANE CITY: HAMPTON STATE: NH ZIP: 03842 BUSINESS PHONE: 6039265911 MAIL ADDRESS: STREET 1: LIBERTY LANE CITY: LIBEHAMPTON STATE: NH ZIP: 03842 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: LEE THOMAS H EQUITY ADVISORS III LP CENTRAL INDEX KEY: 0001055838 RELATIONSHIP: OWNER IRS NUMBER: 043279882 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O THOMAS H LEE CO STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 6172271050 MAIL ADDRESS: STREET 1: C/O THOMAS H LEE CO STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 4 1 a2100830z4.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) Director X 10% Owner Thomas H. Lee Equity Advisors III, Limited Partnership 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) 1/14/03 75 State Street - -------------------------------------------- --------------------- ------------------ ------------------------------------- (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 5,977,006 I (1) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
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 the General Partner of Thomas H. Lee Equity Fund III, L.P. ("Equity Fund III"), Thomas H. Lee Foreign Fund III, L.P. ("Foreign Fund III") and THL FSI Equity Investors, L.P. ("FSI"). The reporting person may be deemed to beneficially own the shares of the Issuer held directly by Equity Fund III, Foreign Fund III and FSI. On January 14, 2003 Equity Fund III, Foreign Fund III, FSI, and the reporting person 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. /s/ Scott M. Sperling 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. 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.
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