-----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, UwBPtmJSior1K9q3p10x3AjDajrUvAAaUKYIb36QWAwtWqXi5qRzbgr6xGxj8Din 6OL0ZU/VqHMS7/3fYKvWrQ== 0000947871-03-000078.txt : 20030114 0000947871-03-000078.hdr.sgml : 20030114 20030110154335 ACCESSION NUMBER: 0000947871-03-000078 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030110 FILED AS OF DATE: 20030110 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ORTHOFIX INTERNATIONAL N V CENTRAL INDEX KEY: 0000884624 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19961 FILM NUMBER: 03510761 BUSINESS ADDRESS: STREET 1: 7 ABRAHAM DE VEERSTRAAT STREET 2: CURACAO CITY: NETHERLANDS ANTILLES STATE: P8 ZIP: 00000 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: GAINES COOPER ROBERT CENTRAL INDEX KEY: 0001213559 RELATIONSHIP: DIRECTOR IRS NUMBER: 000000000 STATE OF INCORPORATION: P8 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: ORTHOFIX INC STREET 2: 7 ABRAM DE VEERATRAST CITY: NETHERLANDS ANTILLEA STATE: P8 ZIP: 9999999999 BUSINESS PHONE: 599 9 465 8525 MAIL ADDRESS: STREET 1: C/O ORCHOFIX INC STREET 2: 10115 KINSEY AVE CITY: HUNTERSVILLE STATE: NC ZIP: 28078 3 1 f3_010903.txt FORM 3 GAINES-COOPER ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0104 Expires: January 31, 2005 Estimated average burden hours per response.........0.5 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3 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(h) of the Investment Company Act of 1940 (Print of Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* Gaines-Cooper Robert - -------------------------------------------------------------------------------- (Last) (First) (Middle) 10115 Kincey Avenue, Suite 250 - -------------------------------------------------------------------------------- (Street) Huntersville, N.C. 28078 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Date of Event Requiring Statement (Month/Day/Year) 01/02/03 ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) ________________________________________________________________________________ 4. Issuer Name and Ticker or Trading Symbol Orthofix International N.V. ("OFIX") ________________________________________________________________________________ 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) |X| Director |_| 10% Owner |X| Officer (give title below) |_| Other (specify below) Chairman --------------------------------------------------------------------------- ________________________________________________________________________________ 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 ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 300,000 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 718,000(1) I By Bird Island Trust - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 220,000(1) I By LMA International S.A. - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
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). Persons who 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) SEC 147 (7-02) FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date -------------------------------- 4. Conver- Security: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option (right to buy) (2) 3/31/03 Common Stock 275,000 $14.40 D - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option (right to buy) (2) 1/1/09 Common Stock 100,000 $17.875 D - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option (right to buy) (3) 1/1/09 Common Stock 87,500 $17.875 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purposes. (2) The option is currently exercisable. (3) The option vests on the earlier of January 1, 2004 or the date on which the closing price of OFIX's Common Stock is $55 or higher consecutively for ten trading days immediately prior to such date. /s/ Robert Gaines-Cooper 1/10/03 - --------------------------------------------- ----------------------- **Signature of Reporting Person 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 is insufficient, see Instruction 6 for procedure. Potentional 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. Page 2 -----END PRIVACY-ENHANCED MESSAGE-----