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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, Section 17(a) of the Public Utility Holding Company Act of 1935 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 | |
CULLIGAN INTERNATIONAL Co 9399 WEST HIGGINS ROAD SUITE 1100 ROSEMONT, IL 60018 |
X | |||
CULLIGAN HOLDING INC. C/O CULLIGAN INTERNATIONAL COMPANY 9399 WEST HIGGINS ROAD, SUITE 1100 ROSEMONT, IL 60018 |
X | |||
CULLIGAN HOLDING Co B.V. C/O CULLIGAN INTERNATIONAL COMPANY 9399 WEST HIGGINS ROAD, SUITE 1100 ROSEMONT, IL 60018 |
X | |||
CULLIGAN HOLDING S.AR.L. C/O CULLIGAN INTERNATIONAL COMPANY 9399 WEST HIGGINS ROAD, SUITE 1100 ROSEMONT, IL 60018 |
X | |||
CULLIGAN INTERNATIONAL S.AR.L. C/O CULLIGAN INTERNATIONAL COMPANY 9399 WEST HIGGINS ROAD, SUITE 1100 ROSEMONT, IL 60018 |
X | |||
CULLIGAN INVESTMENTS S.AR.L. C/O CULLIGAN INTERNATIONAL COMPANY 9399 WEST HIGGINS ROAD, SUITE 1100 ROSEMONT, IL 60018 |
X | |||
CULLIGAN LTD. CANON'S COURT 22 VICTORIA STREET HAMILTON, D0 HM 12 |
X | |||
CLAYTON DUBILIER & RICE FUND VI L P UGLAND HOUSE 113 SOUTH CHURCH STREET GEORGE TOWN, E9 BWI |
X | |||
CD&R ASSOCIATES VI L P UGLAND HOUSE 113 SOUTH CHURCH STREET GEORGE TOWN, E9 BWI |
X | |||
CD&R INVESTMENT ASSOCIATES VI INC UGLAND HOUSE 113 SOUTH CHURCH STREET GEORGE TOWN, E9 BWI |
X |
Culligan International Company by /s/ Susan E. Bennett, Senior Vice President, General Counsel & Secretary | 03/09/2011 | |
**Signature of Reporting Person | Date | |
Culligan Holding Inc. by /s/ Susan E. Bennett, Senior Vice President, General Counsel & Secretary | 03/09/2011 | |
**Signature of Reporting Person | Date | |
Culligan Holding Company B.V. by /s/ Mark A. Seals, Managing Director A | 03/09/2011 | |
**Signature of Reporting Person | Date | |
Culligan Holding S.??r.l. by /s/ Susan E. Bennett, Manager | 03/09/2011 | |
**Signature of Reporting Person | Date | |
Culligan International S.??r.l. by /s/ Susan E. Bennett, Manager | 03/09/2011 | |
**Signature of Reporting Person | Date | |
Culligan Investments S.??r.l. by /s/ Susan E. Bennett, Manager | 03/09/2011 | |
**Signature of Reporting Person | Date | |
Culligan Ltd. by /s/ Susan E. Bennett, Senior Vice President, General Counsel & Assistant Secretary | 03/09/2011 | |
**Signature of Reporting Person | Date | |
See (a) in Remarks below | 03/09/2011 | |
**Signature of Reporting Person | Date | |
See (b) in Remarks below | 03/09/2011 | |
**Signature of Reporting Person | Date | |
See (c) in Remarks below | 03/09/2011 | |
**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) | The shares were acquired in connection with an Asset Purchase Agreement, dated as of March 8, 2011, between Culligan International Company ("Culligan"), Culligan of Canada, Ltd. ("Culligan Canada"), Primo Water Corporation ("Primo") and Primo Refill Canada Corporation ("Primo Canada"), pursuant to which Culligan Canada sold certain assets to Primo Canada in exchange for cash, the assumption of certain liabilities of Culligan Canada by Primo Canada and CAD$3,710,000 in shares of Primo common stock valued based on the average closing price of Primo common stock for the 20 most recent trading days prior to the closing date (with each day's closing price converted from U.S. dollars into Canadian dollars based on the exchange rate on each such day). The shares were issued to Culligan on behalf and upon the direction of Culligan Canada, which is a subsidiary of Culligan. |
(2) | Reflects shares held directly by Culligan International Company. Culligan International Company is a wholly-owned subsidiary of Culligan Holding Inc., which is a wholly-owned subsidiary of Culligan Holding Company B.V., which is a wholly-owned subsidiary of Culligan Holding S.??r.l., which is a wholly-owned subsidiary of Culligan International S.??r.l., which is a wholly-owned subsidiary of Culligan Investments S.??r.l., which is a wholly-owned subsidiary of Culligan Ltd. Clayton, Dubilier & Rice Fund VI Limited Partnership owns approximately 77.8% of the outstanding voting securities of Culligan Ltd. CD&R Associates VI Limited Partnership is the general partner of Clayton, Dubilier & Rice Fund VI Limited Partnership, and CD&R Investment Associates VI, Inc. is the general partner of CD&R Associates VI Limited Partnership. Each of CD&R Associates VI Limited Partnership and CD&R Investment Associates VI, Inc. expressly disclaims beneficial ownership of the shares held directly by Culligan. |
Remarks: (a) Clayton, Dubilier & Rice Fund VI Limited Partnership by CD&R Associates VI Limited Partnership, its general partner, by CD&R Investment Associates VI, Inc., its general partner, by /s/ Theresa A. Gore, Vice President, Treasurer and Assistant Secretary (b) CD&R Associates VI Limited Partnership by CD&R Investment Associates VI, Inc., its general partner, by /s/ Theresa A. Gore, Vice President, Treasurer and Assistant Secretary (c) CD&R Investment Associates VI, Inc. by /s/ Theresa A. Gore, Vice President, Treasurer and Assistant Secretary |