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*
Wicker Damion E.
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(Last) (First) (Middle)
c/o Chase Capital Partners
1221 Avenue of the Americas
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(Street)
New York New York 10020
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(City) (State) (Zip)
05/04/2000
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2. Date of Event Requiring Statement (Month/Day/Year)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
Genomic Solutions Inc.
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4. Issuer Name and Ticker or Trading Symbol
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
05/04/2000
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6. If Amendment, Date of Original (Month/Day/Year)
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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 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. 4)
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<S> <C> <C> <C>
Common Stock 28,880 I (FN 1)
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* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Over)
(Form 3-07/99)
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>
Series C Preferred Callable
Stock (FN 2) Immed N/A Common Stock 3,371,428 1 for 1 I (FN 1)
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Series D Preferred Callable
Stock (FN 2) Immed N/A Common Stock 987,488 1 for 1 I (FN 1)
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Callable
Warrants (FN 3) Immed N/A Common Stock 629,414 0.01 I (FN 1)
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Callable
Options (FN 4) Immed 1/2008 Common Stock 10,000 0.37 for 1 D
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Callable
Options (FN 4) Immed 1/2009 Common Stock 10,000 $2.00 for 1 D
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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, 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 will
be 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
will be 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.
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