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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
GEORGE MARCUS J 10 SOUTH WACKER DRIVE CHICAGO, IL 60606 |
X | X |
/s/ Marcus George, by Sarah Alexander as attorney-in-fact | 03/20/2012 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | This amount represents the $12.00 initial public offering price per share less the underwriting discount of $0.84 per share. |
(2) | CHS Private Equity V LP is the record holder of these securities. Reporting person is a limited partner of CHS Management V LP, which is the general partner of CHS Private Equity V LP. Reporting person disclaims beneficial ownership of the securities except to the extent of a pecuniary interest therein. |
(3) | CHS Private Equity V LP made a distribution of the net proceeds received by it from the initial public offering of the Issuer to its partners. CHS Management V LP, its general partner, elected to receive a portion of its distribution in the form of the Issuer's common stock and received 72,458 shares in respect thereof. Reporting person has a direct interest in 842 of those shares. Reporting person disclaims beneficial ownership of the other 71,616 shares distributed to CHS Management V LP, except to the extent of a pecuniary interest therein. |
(4) | This transaction was omitted from the reporting person's original Form 4. |
(5) | These shares were omitted from the reporting person's original Form 4. |