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FORM 3
U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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(1)
Williams Jeffrey S.
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(Last) (First) (Middle)
4335 Varsity Drive, Suite E
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(Street)
Ann Arbor MI 48108
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2. Date of Event Requiring Statement (Month/Day/Year)
May 4, 2000
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Genomic Solutions Inc., Nasdaq National Market System (GNSL)
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[x] Director [_] 10% Owner
[x] Officer (give title below) [_] Other (specify below)
President and CEO
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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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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>
Callable Common Stock 879,019(1) D
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Callable Common Stock 200,000 I Held in a trust for the benefit of
Jeffrey Williams' children
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
(1) This number includes 3,928 shares of callable common stock that will be
issued upon the automatic exercise of warrants at the closing of the
Company's initial public offering.
(Print of Type Responses)
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FORM 3 (CONTINUED)
TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Securities 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>
Options (1) 3/2005 Callable Common Stock 45,000 .07 D
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Options (2) 1/2006 Callable Common Stock 60,000 .37 D
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Options (3) 5/2010 Callable Common Stock 120,000 7.20 D
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Explanation of Responses:
(1) These options were granted in March 1997 and will vest upon completion of
the Company's initial public offering.
(2) These options were granted in January 1998 and will vest upon completion
of the Company's initial public offering.
(3) These options were granted and 30,000 of these options will vest upon
completion of the Company's initial public offering, and the remaining
120,000 will vest as follows: 30,000 on 5/4/01; 30,000 on 5/4/02; 30,000 on
5/4/03 and 30,000 on 5/4/04.
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/s/ Jeffrey S. Williams 5/4/00
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Signature of Reporting Person(1) Date
Jeffrey S. Williams
(1)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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(Print or Type Responses)
