U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
[_] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person*
Wicker Damion C.
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(Last) (First) (Middle)
c/o Chase Capital Partners
1221 Avenue of the Americas-40th Floor
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(Street)
New York New York 10020
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(City) (State) (Zip)
Genomic Solutions Inc. ("GNSL")
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2. Issuer Name and Ticker or Trading Symbol
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
May 2000
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4. Statement for Month/Year
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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7. 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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<TABLE>
<CAPTION>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock 5/10/00 C 28,880 D N/A 0 I (FNs 1,2)
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Callable Common Stock 5/10/00 C 4,988,330 A N/A 5,017,210 I (FN 1)
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Callable Common Stock 5/10/00 J 28,880 A N/A 5,017,210 I (FNs 1,2)
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</TABLE>
* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
(Over)
(Form 4-07/99)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Callable
Series C Common
Preferred Stock 1 for 1 5/10/00 C 3,371,428 (FN 2) N/A Stock 3,371,428 N/A 0 I (FN 1)
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Callable
Series C Common
Preferred Stock 1 for 1 5/10/00 C 987,488 (FN 2) N/A Stock 987,488 N/A 0 I (FN 1)
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Callable
Common
Warrants 0.01 5/10/00 C 629,414 (FN 3) N/A Stock 629,414 N/A 0 I (FN 1)
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Callable
Common
Options 0.37 for 1 N/A N/A N/A N/A Immed 1/2008 Stock 10,000 N/A 0 I (FN 1)
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Callable
Common
Options $2.00 for 1 N/A N/A N/A N/A Immed 1/2009 Stock 10,000 N/A 0 I (FN 1)
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Callable
Common
Options $7.20 N/A A 10,000 Immed 5/5/10 Stock 10,000 N/A 0 I (FN 1)
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</TABLE>
Explanation of Responses:
(1) The amounts shown represent the beneficial ownership of the Issuer's equity
securities by Chase Venture Capital Associates, LLC, ("CVCA, LLC"), a
portion of which may be deemed attributable to the reporting person because
the reporting person is a general partner of Chase Capital Partners ("CCP"),
which is (i) the sole shareholder of the managing member of CVCA, LLC
and (ii) the manager, by delegation, of CVCA, LLC. The actual pro rata
portion of such beneficial ownership that may be deemed attributable to the
reporting person is not readily determinable because it is subject to
several variables including CVCA, LLC's and CCP's internal rate of return
and vesting. The reporting person disclaims beneficial ownership of the
securities to the extent it exceeds his pecuniary interest in them.
(2) At the close of the initial public offering of the Issuer, each share of
Series C and Series D Preferred Stock and each share of Common Stock was
converted into Callable Common Stock on a 1 for 1 basis.
(3) At the close of the initial public offering of the Issuer, the
Warrants were converted into Callable Common Stock.
(4) The reporting person is contractually obligated to exercise the options at
the request of, and to transfer any shares issued under the stock options
to, CVCA, LLC.
/s/ Damion E. Wicker 6/9/00
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Damion E. Wicker 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.
