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OMB APPROVAL
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OMB Number 3235-0104
Expires: April 30, 1999
Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL 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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
TCW Private Equity Holdings Corp.**
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(Last) (First) (Middle)
200 Park Avenue, Suite 2100
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(Street)
New York New York 10166
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
10/18/99
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Convergence Communications, Inc.
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [ X ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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6. If Amendment, Date of Original (Month/Year)
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7. Individual or Joint/Group Filing (Check applicable line)
[ ] Form Filed by One Reporting Person
[ X ] Form Filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr.5)
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<S> <C> <C> <C>
Series C Preferred Stock 10,000 I TCW Private Equity Holdings Corp. is a member of
- -------------------------------------------------------------------------------- TCW/Latin American Partners L.L.C. TCW Private
Equity Holdings Corp. is a wholly owned subsidiary
of TCW Advisors Inc., which is in turn a wholly
owned subsidiary of TCW Investment Management
Company. TCW Group Inc. is the holding company of
TCW Investment Management Company; Robert Day is
Chairman of the Board and Chief Executive Officer
and a shareholder of TCW Group Inc.; amounts shown
in column 2 represent the reporting persons'
percentage of interest in Series C Preferred
Shares owned by TCW/Latin America Private Equity
Partners L.P., of which TCW/Latin America Partners
L.L.C. is a general partner.
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</TABLE>
* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v)
** Disclaims beneficial ownership
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Page 1 of 2
<PAGE>
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr.5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
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</TABLE>
Explanation of Responses:
/s/ Susan Marsch 10/28/99
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**Signature of Reporting Person Date
** 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 provided is insufficient. See Instruction 6 for procedure.
Alternatively, this form is permitted to be submitted to the
Commission in electronic format at the option of the reporting person
pursuant to Rule 101(b)(4) of Regulation S-T.
Page 2 of 2
(122795DTI)
Joint Filer Information
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Name: TCW Advisors, Inc.**
Address: 200 Park Avenue, Suite 2100
New York, NY 10166
Designated Filer: TCW Private Equity Holdings Corp.
Issuer: Convergence Communications, Inc.
Date of Event Requiring Statement: 10/18/99
Signature: /s/ Susan Marsch
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Authorized Signatory
** Disclaims beneficial ownership
<PAGE>
Joint Filer Information
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Name: TCW Investment Management Company**
Address: 865 South Figueroa Street, Suite 1800
Los Angeles, California 90017
Designated Filer: TCW Private Equity Holdings Corp.
Issuer: Convergence Communications, Inc.
Date of Event Requiring Statement: 10/18/99
Signature: /s/ Susan Marsch
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Authorized Signatory
** Disclaims beneficial ownership
<PAGE>
Joint Filer Information
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Name: The TCW Group, Inc.**
Address: 865 South Figueroa Street, Suite 1800
Los Angeles, California 90017
Designated Filer: TCW Private Equity Holdings Corp.
Issuer: Convergence Communications, Inc.
Date of Event Requiring Statement: 10/18/99
Signature: /s/ Susan Marsch
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Authorized Signatory
** Disclaims beneficial ownership
<PAGE>
Joint Filer Information
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Name: Robert A. Day
Address: 200 Park Avenue, Suite 2100
New York, NY 10166
Designated Filer: TCW Private Equity Holdings Corp.
Issuer: Convergence Communications, Inc.
Date of Event Requiring Statement: 10/18/99
Signature: /s/ Susan Marsch
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Under Power of Attorney, dated March, 31,
1999, on file with Schedule 13G for Hibbett
Sporting Goods, Inc., dated April 9, 1999.
