- Statement of Changes in Beneficial Ownership (4)
May 27 2011 - 6:47PM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
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1. Name and Address of Reporting Person
*
LEBLANC ROBERT M
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2. Issuer Name
and
Ticker or Trading Symbol
Emergency Medical Services CORP
[
EMS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
C/O ONEX INVESTMENT CORPORATION, 712 FIFTH AVENUE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
5/25/2011
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(Street)
NEW YORK, NY 10019
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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LP Exchangeable Units
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(1)
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5/25/2011
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D
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56064
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12/20/2005
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(2)
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Class A Common Stock
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56064
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(3)
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0
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I
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by Onex US Principals LP and Onex EMSC Co-Invest LP
(4)
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Explanation of Responses:
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(
1)
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The LP Exchangeable Units represent equity interests in Emergency Medical Services L.P. Each LP Exchangeable Unit is exchangeable at any time, at the option of the holder, for one share of the issuer's Class B Common Stock. Each share of Class B Common Stock is convertible at any time, at the option of the holder, into one share of the issuer's Class A Common Stock.
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(
2)
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Not applicable.
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(
3)
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Disposed of pursuant to the merger agreement dated as of February 13, 2011, by and among the issuer, CDRT Acquisition Corporation and CDRT Merger Sub, Inc. in exchange for the merger consideration of $64.00 per share in cash.
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(
4)
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Mr. LeBlanc does not hold these units directly. These are deemed shares of Class B common stock and include (i) 35,814 LP Exchangeable Units held by Onex US Principals LP, which may be deemed owned beneficially by Mr. LeBlanc by reason of his pecuniary interest in the LP Exchangeable Units owned by Onex US Principals LP and (ii) 20,250 LP Exchangeable Units owned by Onex EMSC Co-Invest LP, which may be deemed to be owned beneficially by Mr. LeBlanc by reason of his pecuniary interest in Onex EMSC Co-Invest LP. Mr. LeBlanc disclaims beneficial ownership of the LP Exchangeable Units owned by Onex US Principals LP and Onex EMSC Co-Invest LP.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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LEBLANC ROBERT M
C/O ONEX INVESTMENT CORPORATION
712 FIFTH AVENUE
NEW YORK, NY 10019
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X
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Signatures
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/s/ Carl F. Berglind, as attorney-in-fact
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5/26/2011
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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