UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
AS Investors, LLC C/O AMERICAN SECURITIES LLC THE CHRYSLER CENTER, 666 THIRD AVENUE NEW YORK, NY 10017 |
 |  X |  |  |
American Securities Partners V, L.P. C/O AMERICAN SECURITIES LLC THE CHRYSLER CENTER, 666 THIRD AVENUE NEW YORK, NY 10017 |
 |  X |  |  |
American Securities Partners V(B), L.P. C/O AMERICAN SECURITIES LLC THE CHRYSLER CENTER, 666 THIRD AVENUE NEW YORK, NY 10017 |
 |  X |  |  |
American Securities Partners V (C) L.P. C/O AMERICAN SECURITIES LLC THE CHRYSLER CENTER, 666 THIRD AVENUE NEW YORK, NY 10017 |
 |  X |  |  |
American Securities Associates V, LLC C/O AMERICAN SECURITIES LLC THE CHRYSLER CENTER, 666 THIRD AVENUE NEW YORK, NY 10017 |
 |  X |  |  |
AMERICAN SECURITIES LLC THE CHRYSLER CENTER 666 THIRD AVENUE NEW YORK, NY 10017 |
 |  X |  |  |
Saiontz Marc C/O AMERICAN SECURITIES LLC THE CHRYSLER CENTER, 666 THIRD AVENUE NEW YORK, NY 10017 |
 X |  |  |  |
AS Investors, LLC By: /s/ Marc Saiontz, as Vice President | 06/03/2010 | |
**Signature of Reporting Person | Date | |
American Securities Partners V, L.P. By: American Securities Associates V, LLC, its general partner By: /s/ Michael G. Fisch, as Managing Member | 06/03/2010 | |
**Signature of Reporting Person | Date | |
American Securities Partners V(B), L.P. By: American Securities Associates V, LLC, its general partner By: /s/ Michael G. Fisch, as Managing Member | 06/03/2010 | |
**Signature of Reporting Person | Date | |
American Securities Partners V(C), L.P. By: American Securities Associates V, LLC, its general partner By: /s/ Michael G. Fisch, as Managing Member | 06/03/2010 | |
**Signature of Reporting Person | Date | |
American Securities Associates V, LLC By: /s/ Michael G. Fisch, as Managing Member | 06/03/2010 | |
**Signature of Reporting Person | Date | |
American Securities LLC By: /s/ Michael G. Fisch, as President and Chief Executive Officer | 06/03/2010 | |
**Signature of Reporting Person | Date | |
/s/ Marc Saiontz | 06/03/2010 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The shares are directly owned by AS Investors, LLC and may also be deemed to be indirectly beneficially owned by: (i) American Securities Partners V, L.P., American Securities Partners V(B), L.P. and American Securities Partners V(C), L.P. (each, a "Sponsor"), the owners of membership interests in AS Investors, LLC; (ii) American Securities Associates V, LLC ("GP"), the general partner of each Sponsor; and (iii) American Securities LLC, which provides investment advisory services to each Sponsor and GP. |
(2) | Each Reporting Person disclaims beneficial ownership of the reported securities except to the extent of such Reporting Person's pecuniary interest therein, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of the securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. |
(3) | No shares are owned by Marc Saiontz, a managing director of American Securities LLC (and a director of Xerium Technologies, Inc.). |