4 1 hag4.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* Hagerty Thomas M. -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Thomas H. Lee Partners, L.P. 75 State Street -------------------------------------------------------------------------------- (Street) Boston MA 02109 -------------------------------------------------------------------------------- (City) (State) (Zip) -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Cott Corporation (COTT) -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) -------------------------------------------------------------------------------- 4. Statement for Month/Year July 2002 -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/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) [X] Form filed by one Reporting Person [_] 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) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/27/02 C 5,048,095(8) A I (1) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/27/02 C 174,855(8) A I (2) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/27/02 C 491,429(8) A I (3) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/27/02 C 136,686(8) A I (4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 7/5/02 X 4,015,059(8) A 9.00 I (1) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 7/5/02 X 139,072(8) A 9.00 I (2) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 7/5/02 X 390,864(8) A 9.00 I (3) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 7/5/02 X 108,719(8) A 9.00 19,812,208 I (1)(2)(3)(4)(8) (4) ====================================================================================================================================
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). (Print or Type Response) (Over) 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) ------------------------------------------------------------------------------------------------------------------------------------ Convertible Participating Voting Second Preferred Shares, Series I (5) 6/27/02 C 4,926,599(6) Immed. Common 5,048,095(7) 0 I (1) ------------------------------------------------------------------------------------------------------------------------------------ Convertible Participating Voting Second Preferred Shares, Series I (5) 6/27/02 C 170,646(6) Immed. Common 174,855(7) 0 I (2) ------------------------------------------------------------------------------------------------------------------------------------ Convertible Participating Voting Second Preferred Shares, Series I (5) 6/27/02 C 479,602(6) Immed. Common 491,429(7) 0 I (3) ------------------------------------------------------------------------------------------------------------------------------- Convertible Participating Voting Second Preferred Shares, Series I (5) 6/27/02 C 133,397(6) Immed. Common 136,686(7) 0 I (4) -------------------------------------------------------------------------------------------------------------------------------- Stock Option (right to buy) 9.00 7/5/02 X 4,015,059 Immed. 7/7/02 Common 4,015,059 0 I (1) ------------------------------------------------------------------------------------------------------------------------------------ Stock Option (right to buy) 9.00 7/5/02 X 139,072 Immed. 7/7/02 Common 139,072 0 I (2) -------------------------------------------------------------------------------------------------------------------------------- Stock Option (right to buy) 9.00 7/5/02 X 390,864 Immed. 7/7/02 Common 390,864 0 I (3) -------------------------------------------------------------------------------------------------------------------------------- Stock Option (right to buy) 9.00 7/5/02 X 108,719 Immed. 7/7/02 Common 108,719 0 I (4) ==================================================================================================================================== Explanation of Responses:
(1) Represents shares owned by Thomas H. Lee Equity Fund IV, L.P. (2) Represents shares owned by Thomas H. Lee Foreign Fund IV, L.P. (3) Represents shares owned by Thomas H. Lee Foreign Fund IV-B, L.P. (4) Represents shares owned by Thomas H. Lee THL-Coinvestors III-B, LLC. (5) The conversion ratio at the time of conversion was 1.5716129-for-1.00. (6) This number reflects a conversion ratio of approximately 1.54-for-1.00, which was increased to 1.5716129-for-1.00 prior to the conversion. (7) Reflects the number of shares, as adjusted by the conversion ratio. (8) 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 his pecuniary interest therein. /s/ Thomas M. Hagerty 8/12/02 --------------------------------------------- ----------------------- **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 provided is insufficient, see Instruction 6 for procedure.