-----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, DDeurF1ps1U6dQm+66/qT+vmxZfFzzNgJDsAvSXQTymfNpnaKhgeBhS1vDT+AWiW /jrgRT0aROUysgtzIcfDog== 0001106605-02-000108.txt : 20021112 0001106605-02-000108.hdr.sgml : 20021111 20021112151006 ACCESSION NUMBER: 0001106605-02-000108 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021023 FILED AS OF DATE: 20021112 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: BLUTT MITCHELL J MD CENTRAL INDEX KEY: 0001097955 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O CHASE CAPITAL PARTNERS STREET 2: 380 MADISON AVENUE 12TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 2126223100 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: 02816936 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 4 1 bluttfishform4_102302.txt FORM 4 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 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 of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ________________________________________________________________________________ 1. Name and Address of Reporting Person* Blutt Mitchell J. - -------------------------------------------------------------------------------- (Last) (First) (Middle) J.P. Morgan Partners, LLC 1221 Avenue of the Americas-40th Floor - -------------------------------------------------------------------------------- (Street) New York New York 10020 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Fisher Scientific International, Inc. ("FSH") ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Day/Year October 23, 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [_] 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. 2A. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Deemed Code ------------------------------- Owned Follow- (D) or Indirect 1. Transaction Execution (Instr. 8) (A) ing Reporte- Indirect Beneficial Title of Security Date Date, if any ------------ Amount or Price ed Trans- (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V (D) actions (Instr.4) (Instr. 4) (Instr. 3 and 4) - ------------------------------------------------------------------------------------------------------------------------------------ Nonvoting J Common Stock 10/23/02 (FN 1) 6,361 A N/A 6,361 I (FN 1) - ------------------------------------------------------------------------------------------------------------------------------------ Nonvoting (FNs 2 Common Stock N/A N/A N/A N/A N/A 3,207,809 I and 3) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* 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- 3A.Deemed 4. Securities Date Securities Price Bene- ity: In- cise 3. Exec- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- cution action or Disposed Expiration Date ---------------- Deriv- Owned (D)or Bene- 1. of action Date, Code of(D) (Month/Day/Year) Amount ative Follow- In- ficial Title of Deriv- Date (Month/ (Instr. (Instr. 3, ---------------- or Secur- ing Repo direct Owner- Derivative ative (Month/ Day/ 8) 4 and 5) Date Expira- Number ity rted (I) ship Security Secur- Day/ (Year ------ ------------ Exer- tion of (Instr. Transact-(Instr.(Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) ion(s) 4) 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Nonvoting Non- Common Voting Stock Common (FNs 2 Warrants $48.25 N/A N/A N/A N/A 1/21/98 1/21/08 Stock 332,045 332,045 I and 3) - ------------------------------------------------------------------------------------------------------------------------------------ - ----------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) These shares were received by Chemical Investments, Inc. ("CII"), upon a distribution of the shares of the Issuer by Thomas H. Lee Equity Fund III, L.P. and Thomas H. Lee Foreign Fund III, L.P., a limited partnership in which CII is a limited partner. The Reporting Person or J.P. Morgan Partners (BHCA), L.P. ("JPM BHCA") has no pecuniary or other interest in the shares held by CII, a wholly-owned subsidiary of J.P. Morgan Chase & Co. (2) The amounts shown in line 2 of Table I and line 1 of Table II represent the beneficial ownership of the Issuer's equity securities by JPM BHCA, a portion of which may be deemed attributable to the Reporting Person because the Reporting Person is an Executive Vice President of JPMP Capital Corp (the general partner of JPMP Master Fund Manager L.P. ("MF Manager")), the general partner of JPM BHCA. The Reporting Person is also a limited partner of MF Manager. Dr. Blutt disclaims beneficial ownership of such securities except to the extent of his pecuniary interest in MF Manager. (3) JPM BHCA and several other shareholders of the Issuer are party to an Amended and Restated Investors' Agreement (the "Agreement") pertaining to the voting and disposition of their respective shares. As a result thereof, the parties to the Agreement may constitute a "group" for purposes of the Securities Exchange Act of 1934, as amended. JPM BHCA and the Reporting Person disclaim beneficial ownership of the shares held by the other parties to the Agreement. According to the Form 424(b)(1) prospectus of the Issuer filed with the Securities and Exchange Commission on February 13, 2002, upon completion of the offering described in the prospectus, but prior to any exercise of the underwriters' over-allotment option, selling shareholders party to the Investors' Agreement other than JPM BHCA beneficially owned voting securities and warrants or other securities convertible into 24,196,509 shares (approximately 47.2%), and management and other individuals party to the Investors' Agreement and their affiliates beneficially owned voting securities and warrants or other securities convertible into voting securities, aggregating in excess of 4,101,420 shares (approximately 7.2%) of the voting securities of the Issuer. /s/ Mitchell J. Blutt 11/12/02 - --------------------------------------------- ----------------------- Mitchell J. Blutt Date ** 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. NAME AND ADDRESS OF DESIGNATED STATEMENT DEEMED EXECUTION ISSUER NAME, TICKER REPORTING PERSON REPORTER FOR DATE IF ANY OR TRADING SYMBOL (Note 1) MONTH/DAY/YEAR (MONTH/DAY/YEAR) - ----------------------------------------------------------------------------------------------------------------------------------- JPMP Master Fund Manager, L.P. J.P. Morgan Partners October 23, 2002 N/A Fisher Scientific c/o J.P. Morgan Partners, LLC (BHCA), LP International, Inc. ("FSH") 1221 Avenue of the Americas 40th Floor New York, NY 10020 - ------------------------------------------------------------------------------------------------------------------------------------ JPMP Capital Corporation J.P. Morgan Partners October 23, 2002 N/A Fisher Scientific c/o J.P. Morgan Partners, LLC (BHCA), LP International, Inc. ("FSH") 1221 Avenue of the Americas 40th Floor New York, NY 10020 - ------------------------------------------------------------------------------------------------------------------------------------ J.P. Morgan Chase & Co. J.P. Morgan Partners October 23, 2002 N/A Fisher Scientific 270 Park Avenue (BHCA), LP International, Inc. ("FSH") 35th Floor New York, NY 10017 - ------------------------------------------------------------------------------------------------------------------------------------ Chatham Ventures, Inc. J.P. Morgan Partners October 23, 2002 N/A Fisher Scientific c/o J.P. Morgan Partners, LLC (BHCA), LP International, Inc. ("FSH") 1221 Avenue of the Americas- 40th Floor New York, NY 10020 - ------------------------------------------------------------------------------------------------------------------------------------ Chemical Investments, Inc J.P. Morgan Partners October 23, 2002 N/A Fisher Scientific 380 Madison Avenue (BHCA), LP International, Inc. ("FSH") New York, NY 10017 - ------------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------- TITLE OF DERIVATIVE SECURITIES AND TITLE AND AMOUNTS OF SECURITIES NAME AND ADDRESS OF TITLE OF AMOUNT OF UNDERLYING OWNERSHIP FORM: NATURE OF INDIRECT DISCLAIMS REPORTING PERSON SECURITY SECURITIES DERIVATIVE DIRECT (D) OR BENEFICIAL OWNERSHIP PECUNIARY (Note 1) BENEFICIALLY SECURITIES INDIRECT (I) INTEREST OWNED FOLLOW- REPORTED TRANSACTION(S) - ------------------------------------------------------------------------------------------------------------------------------------ JPMP Master Fund Manager, L.P. Nonvoting See Tables I See Table II I See Explanatory No c/o J.P. Morgan Partners, LLC Common Stock and II above above Note 2 below 1221 Avenue of the Americas 40th Floor New York, NY 10020 - ------------------------------------------------------------------------------------------------------------------------------------ JPMP Capital Corporation Nonvoting See Tables I See Table II I See Explanatory No c/o J.P. Morgan Partners, LLC Common Stock and II above above Note 3 below 1221 Avenue of the Americas 40th Floor New York, NY 10020 - ------------------------------------------------------------------------------------------------------------------------------------ J.P. Morgan Chase & Co. Nonvoting See Tables I See Table II I See Explanatory No 270 Park Avenue Common Stock and II above above Note 4 below 35th Floor New York, NY 10017 - ------------------------------------------------------------------------------------------------------------------------------------ Chatham Ventures, Inc. Nonvoting See Tables I See Table II I See Explanatory No c/o J.P. Morgan Partners, LLC Common Stock and II above above Note 5 below 1221 Avenue of the Americas 40th Floor New York, NY 10020 - ------------------------------------------------------------------------------------------------------------------------------------ Chemical Investments, Inc. Nonvoting See Table I -0- D See Explanatory No 380 Madison Avenue Common Stock line 1 above Note 6 below New York, NY 10017 - ------------------------------------------------------------------------------------------------------------------------------------
(1) The Designated Reporter is executing this report on behalf of all Reporting Persons, each of whom has authorized it to do so. Each of such Persons disclaims beneficial ownership of the securities to the extent it exceeds such Person's pecuniary interest therein. (2) The amounts shown in line 2 of Table I and line 1 of Table II represent the beneficial ownership of the Issuer's equity securities by J.P. Morgan Partners (BHCA), L.P. ("JPM BHCA"). A portion of the securities may be deemed attributable to the Reporting Person because the Reporting Person is the general partner of JPM BHCA. The actual pro rata portion of such beneficial ownership that may be deemed to be attributable to the Reporting Person is not readily determinable because it is subject to several variables, including the internal rate of return and vesting of interests within JPM BHCA. (3) The amounts shown in line 2 of Table I and line 1 of Table II represent the beneficial ownership of the Issuer's equity securities by JPM BHCA, a portion of which may be deemed attributable to the Reporting Person because the Reporting Person is the sole stockholder of JPMP Master Fund Manager ("MF Manager"), the general partner of JPM BHCA. The actual pro rata portion of such beneficial ownership that may be deemed attributable to the Reporting Person is not readily determinable because it is subject to several variables, including the internal rate of return and vesting within JPM BHCA and MF Manager. (4) The amounts shown in Table I represent the beneficial ownership of the Issuer's equity securities by Chemical Investments, Inc., and JPM BHCA respectively, a portion of which may be deemed attributable to the Reporting Person because it is (a) the sole stockholder of JPMP Capital Corporation (the general partner of MF Manager) and of Chatham Ventures, Inc., the limited partner of JPM BHCA, and (b) the sole stockholder of Chemical Investments, Inc. The actual pro rata portion of such beneficial ownership that may be attributable to the Reporting Person is not readily determinable because it is subject to several variables, including the internal rate of return and vesting of interests within JPM BHCA and MF Manager. (5) The amounts shown in line 2 of Table I and line 1 of Table II represent the beneficial ownership of the Issuer's equity securities by JPM BHCA, a portion of which may be deemed attributable to the Reporting Person because it is the sole limited partner of JPM BHCA. The actual pro rata portion of such beneficial ownership that may be deemed to be attributable to the Reporting Person is not readily determinable because it is subject to several variables, including the internal rate of return and vesting of interests within JPM BHCA. (6) The amounts shown in line 2 of Table I and line 1 of Table II represent the beneficial ownership of the Issuer's equity securities by JPM BHCA. Chemical Investments, Inc. is an affiliate of JPM BHCA, but has no beneficial or pecuniary interest in the equity securities owned by JPM BHCA. -----END PRIVACY-ENHANCED MESSAGE-----