-----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, F6sGJNRSSbtCP/BjXt331OLRhBmsTBtrYl1hlpqghL/Aoe1TV9o6OKnTJDrg1jAI SuLoE0SAXK33MUwM4oiwuQ== 0000899140-99-000520.txt : 19991018 0000899140-99-000520.hdr.sgml : 19991018 ACCESSION NUMBER: 0000899140-99-000520 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991001 FILED AS OF DATE: 19991012 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: COVENTRY HEALTH CARE INC CENTRAL INDEX KEY: 0001054833 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-OFFICES & CLINICS OF DOCTORS OF MEDICINE [8011] IRS NUMBER: 522073000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-29676 FILM NUMBER: 99726896 BUSINESS ADDRESS: STREET 1: 6705 ROCKLEDGE DR STE 100 CITY: BETHESDA STATE: MD ZIP: 20817 BUSINESS PHONE: 3015810600 MAIL ADDRESS: STREET 1: 6705 ROCKLEDGE DR SUITE 100 STREET 2: STE 250 CITY: BETHESDA STATE: MD ZIP: 20817 COMPANY DATA: COMPANY CONFORMED NAME: WARBURG PINCUS VENTURES LP CENTRAL INDEX KEY: 0000942263 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] DIRECTOR IRS NUMBER: 133784037 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: E M WARBURG PINCUS & CO INC STREET 2: 466 LEXINGTON AVE 10TH FL CITY: NEW YORK STATE: NY ZIP: 10017-3147 BUSINESS PHONE: 2128780600 MAIL ADDRESS: STREET 1: E M WARBURG PINCUS & CO INC STREET 2: 466 LEXINGTON AVE 10TH FL CITY: NEW YORK STATE: NY ZIP: 10017-3147 4 1 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
FORM 4 OMB APPROVAL - -------------------- ------------------------------ [ ] Check this box if no longer subject to Section OMB Number: 3235-0287 16. Form 4 or Form 5 obligations may Expires: September 30, 1998 continue. See Instruction 1(b). Estimated average burden hours per response 0.5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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 - ----------------------------------------- -------------------------------------------- --------------------------------------------- 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) Warburg, Pincus Ventures, L.P. Coventry Health Care, Inc. (CVTY) - ----------------------------------------- -------------------------------------------- (Last) (First) (Middle) 3. IRS or Social 4. Statement for [X] Director [X] 10% Owner Security Number Month/Year [ ] Officer (give [X] Other (specify of Reporting title below) below) Person 466 Lexington Avenue (Voluntary) Trustee - ----------------------------------------- ------------------------- --------------------------------------------- (Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing Original (Month/Year) (Check Applicable Line) [ ] Form filed by One Reporting Person [X] Form filed by More than One Reporting New York New York 10017 Person - ----------------------------------------- ------------------ ------------------------- --------------------------------------------- (City) (State) (Zip)
- ------------------------------------------------------------------------------------------------------------------------------------ Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security (Instr. 3) 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature action action or Disposed of (D) Securities ship of In- Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 8) Owned at Direct Bene- (Month/ End of (D) or ficial Day/ Month Indirect Owner- Year) (Instr. 3 (I) ship and 4) (Instr. 4) (Instr. 4) ------------ --------------------------- Code V Amount (A) or (D) Price - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ - --------------------------------- ------------- ------ --- ------ ---------- ------- ----------------- ------------ ------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) SEC 1474 (7-96) *If the form is filed by more than one reporting person, see Instruction 4(b)(v).
FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) - --------------------------------------------------------------------------------------------------------------------------- 1. Title of 2. Conver- 3.Trans- 4. Transac- 5. Number of 6. Date Exer- 7. Title and Amount of Derivative sion or action tion Code Derivative cisable and Underlying Securities Security Exercise Date (Instr. 8) Securities Expiration (Instr. 3 and 4) (Instr. 3) Price of (Month/ Acquired (A) Date (Month/ Derivative Day/ or Disposed Day/Year) Security Year) of (D) (Instr.3, 4, and 5) Code V (A) (D) Date Expira- Amount or Exer- tion Title Number of cisable Date Shares - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- Convertible December Exchangeable Note 9/3/99 C $42,358,400 (1) 1, 2004 - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- Series A Preferred Stock $10.00 9/3/99 C 4,235,840 (3) 4,235,840(4) - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- - --------------------- -------------- ---------- ------ ------ ------ --------- -------- --------- ----------- ------------- ** 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.
[CONTINUATION OF THE ABOVE CHART] - -------------------------------------------------------------------- 8. Title of 9. Number 10. Owner- 11. Nature Derivative of Deriv- ship of In- Security ative Form direct (Instr. 3) Secur- of De- Bene- ities rivative ficial Bene- Secu- Owner- ficially rity: ship Owned Direct (Instr. 4) at (D) or End Indi- of rect (I) Month (Instr. 4) (Instr. 4) - --------------- --------------- ---------------- ------------------- I(2) By Warburg, Pincus Ventures, L.P. and Voting Trust (2) - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- ------------------- - --------------- --------------- ---------------- -------------------
SEC 1474 (7-96) Explanation of Responses: - ------------------------- 1) The Convertible Exchangeable Note may be exchanged for Series A Preferred Stock at any time at the option of the Company. 2) Pursuant to a Voting Trust Agreement, dated April 15, 1997, among Patrick T. Hackett, Joel Ackerman and Jonathan S. Leff, as Trustees (collectively, the "Trustees") and Warburg, Pincus Ventures, L.P., a Delaware limited partnership ("Ventures"), (as supplemented as of November 12, 1997, the "Voting Trust"), Ventures vested the power to vote all of the shares of Common Stock and all of the shares of Series A Preferred Stock which Ventures may acquire upon conversion, exchange or exercise of the Convertible Exchangeable Senior Subordinated Notes due 2004 (the "Notes") and Warrants (the "Warrants," and, collectively with the Notes, the "Securities") of the Company irrevocably in the Voting Trust until April 15, 2007; provided, however, that Ventures may terminate the Voting Trust upon written notice to the Trustees if Ventures is deemed to own beneficially (within the meaning of Rule 13d-3 under the Securities Exchange Act of 1934, as amended (the "Exchange Act")) less than ten percent (10%) of the then outstanding shares of Common Stock. By reason of the provisions of Rule 16a-1 of the Exchange Act, the Voting Trust and the Trustees may be deemed to be the beneficial owner of the Securities held by Ventures, although the Voting Trust and each of the Trustees disclaim beneficial ownership of such Securities. Additionally, the sole general partner of Ventures is Warburg, Pincus & Co., a New York general partnership ("WP"). Lionel I. Pincus is the managing partner of WP and he may be deemed to control it. E.M. Warburg, Pincus & Co., LLC, a New York limited liability company ("EMW"), many of whose members are also general partners of WP, manages Ventures. By reason of the provisions of Rule 16a-1 of the Exchange Act, WP and EMW may be deemed to be the beneficial owner of the Securities held by Ventures, although both WP and EMW disclaim beneficial ownership of such Securities except to the extent of any indirect pecuniary interest therein. Mr. Hackett and Mr. Moorhead, directors of the Company, are general partners of WP and members of EMW. As such, each of Mr. Hackett and Mr. Moorhead may be deemed to have an indirect pecuniary interest (within Rule 16a-1 of the Exchange Act) in an indeterminate portion of the Securities beneficially owned by Ventures, EMW, WP and the Voting Trust. Each of Mr. Hackett and Mr. Moorhead disclaims beneficial ownership of such securities except to the extent of any indirect pecuniary interest therein. In addition, Mr. Hackett, Mr. Ackerman and Mr. Leff are each Trustees under the Voting Trust. Mr. Hackett, Mr. Ackerman and Mr. Leff each disclaim beneficial ownership of such Securities except to the extent of any indirect pecuniary interest therein. 3) The Series A Preferred Stock may be exchanged for shares of Common Stock at any time at the option of Ventures. 4) The number of shares of shares of Common Stock into which the Series A Convertible Preferred Stock may be converted is subject to standard anti-dilution provisions. 1. Name: Rodman W. Moorhead, III (Director) Address: 466 Lexington Avenue New York, New York 10017 2. Name: Patrick T. Hackett (Director and Trustee) Address: 466 Lexington Avenue New York, New York 10017 3. Name: Joel Ackerman (Trustee) Address: 466 Lexington Avenue New York, New York 10017 4. Name: Jonathan S. Leff (Trustee) Address: 466 Lexington Avenue New York, New York 10017 5. Name: Warburg, Pincus & Co. (General Partner) Address: 466 Lexington Avenue New York, New York 10017 6. Name: E.M. Warburg, Pincus & Co., LLC (Manager of WPV) Address: 466 Lexington Avenue New York, New York 10017 Designated Filer: Warburg, Pincus Ventures, L.P. Issuer & Ticker Symbol: Coventry Health Care, Inc. (CVTY) Period Covered By Form: October 1999 WARBURG, PINCUS VENTURES, L.P. By: Warburg, Pincus & Co., General Partner By: /s/ Stephen Distler October 12, 1999 ------------------------------ ---------------- Stephen Distler Date Partner WARBURG, PINCUS & CO. By: /s/ Stephen Distler October 12, 1999 ------------------------------ ---------------- Stephen Distler Date Partner E.M. WARBURG, PINCUS & CO., LLC By: /s/ Stephen Distler October 12, 1999 ------------------------------ ---------------- Stephen Distler Date Member Director /s/ Rodman W. Moorhead, III October 12, 1999 ------------------------------ ---------------- Rodman W. Moorhead, III Date Trustee & Director /s/ Patrick T. Hackett October 12, 1999 ------------------------------ ---------------- Patrick T. Hackett Date Trustee /s/ Joel Ackerman October 12, 1999 ------------------------------ ---------------- Joel Ackerman Date Trustee /s/ Jonathan S. Leff October 12, 1999 ------------------------------ ---------------- Jonathan S. Leff Date -----END PRIVACY-ENHANCED MESSAGE-----