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) 01/27/2017 | 3. Issuer Name and Ticker or Trading Symbol JELD-WEN Holding, Inc. [ JELD ] | |||||||||||||
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) |
Common Stock | 7,630 | I | See footnote(1) |
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 | ||||
Series A Preferred Stock | 05/31/2016 | (3) | Common Stock | 96,258(2) | (4) | I | See footnote(5) |
Explanation of Responses: |
1. Represents the reporting person's pecuniary interest in shares of Common Stock owned of record by Onex US Principals LP, Onex Partners III LP, Onex Partners II PV LP, Onex BP Co-invest LP and Onex Partners III Select LP (the "Onex Entities"). Does not include a contingent pecuniary interest in additional shares, based on performance. |
2. In each case, 78.5%, 5.0% and 16.5% of the reported shares of Common Stock represent shares issuable upon conversion of the Series A-1 Preferred Stock, Series A-2 Preferred Stock and Series A-3 Preferred Stock, respectively. |
3. No expiration date. |
4. Each share of Series A-1, Series A-2 and Series A-3 Preferred Stock is convertible into 1.567086, 1.416214 and 1.140649 shares of Common Stock, respectively, at any time, at the option of the holder. The Series A Preferred Stock has no expiration date. Immediately prior to the consummation of the initial public offering of the issuer's Common Stock, the Series A Preferred Stock is expected to be converted into Common Stock. |
5. Represents the reporting person's pecuniary interest in shares of Common Stock issuable upon conversion of shares of Series A Preferred Stock owned of record by the Onex Entities. Does not include a contingent pecuniary interest in additional shares, based on performance. |
Remarks: |
/s/ Anthony Munk | 01/27/2017 | |
** 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. |