SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 05/11/2016 | 3. Issuer Name and Ticker or Trading Symbol SiteOne Landscape Supply, Inc. [ SITE ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Cumulative Convertible Participating Preferred Stock | (1) | (2) | Common Stock | 25,303,164(1)(3) | (1) | I | By affiliate(4)(5) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. Reflects 216,789.33155 shares of Cumulative Convertible Participating Preferred Stock ("Preferred Stock") held by CD&R Landscapes Holdings, L.P. ("CD&R Holdings"). At any time, CD&R Holdings may elect to convert its shares of Preferred Stock to shares of Common Stock at the conversion ratio specified in the Certificate of Designations, Preferences and Rights for the Preferred Stock. Following such conversion, any fractional shares will be cashed out at fair market value. On the business day immediately prior to the anticipated closing of the Issuer's initial public offering of Common Stock, CD&R Holdings will convert all of the Preferred Stock into shares of Common Stock at the conversion ratio as of such date of 116.71775, which includes accrued and unpaid dividends through the conversion date. |
2. Upon certain change of control events, the Preferred Stock must be redeemed, for an amount equal to either (at the option of CD&R Holdings): (x) the same consideration as paid for shares of Common Stock on an as-converted basis or (y) its liquidation preference. |
3. As a holder of Preferred Stock, CD&R Holdings is entitled to (x) a 12% fixed, cumulative dividend payable quarterly ("Quarterly Dividend") and (y) dividends on an as-converted basis if and when declared on the Issuer's common stock, subject to certain conditions. As of the date hereof, the Issuer can elect to pay the Quarterly Dividend in cash or shares of Preferred Stock. |
4. CD&R Holdings directly owns 216,789.33155 shares of Preferred Stock. CD&R Associates VIII, Ltd., as the general partner of CD&R Holdings, CD&R Associates VIII, L.P., as the sole stockholder of CD&R Associates VIII, Ltd., and CD&R Investment Associates VIII, Ltd., as the general partner of CD&R Associates VIII, L.P., may each be deemed to beneficially own the shares of Common Stock held by CD&R Holdings. |
5. Each of CD&R Associates VIII, Ltd., CD&R Associates VIII, L.P. and CD&R Investment Associates VIII, Ltd. expressly disclaims beneficial ownership of the shares of Preferred Stock held by CD&R Holdings and the shares of Common Stock into which they are convertible, except to the extent of its pecuniary interest therein. |
Remarks: |
CD&R Associates VIII, Ltd. By: /s/ Theresa A. Gore, VP, Treas. and Asst. Sec. | 05/11/2016 | |
CD&R Associates VIII, L.P. By: CD&R Investment Associates VIII, Ltd., its general partner, By: /s/ Theresa A. Gore, VP, Treas. and Asst. Sec. | 05/11/2016 | |
CD&R Investment Associates VIII, Ltd. By: /s/ Theresa A. Gore, VP, Treas. and Asst. Sec. | 05/11/2016 | |
CD&R Landscapes Holdings, L.P. By: CD&R Associates VIII, Ltd., its general partner, By: /s/ Theresa A. Gore, VP, Treas. and Asst. Sec. | 05/11/2016 | |
** Signature of Reporting Person | Date | |
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). | ||
** 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. | ||
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 Number. |