U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 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*
Grossman Richard
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(Last) (First) (Middle)
101 East 52nd Street
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(Street)
New York New York 10022
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
10/27/00
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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
Merrimac Industries, Inc. (MRM)
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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/Day/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. 5) (Instr. 5) (Instr.5)
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<S> <C> <C> <C>
Common Stock 20,000 (1) (D)
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Common Stock 91,200 (2) (D)
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Common Stock 104,300 (3) (I) (4)
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</TABLE>
* 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.
Page 1 of 2
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FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
<TABLE>
<CAPTION>
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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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Warrants Immed. 10/26/03 Common Stock 20,000(1) $21.25 (D)
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Warrants Immed. 10/26/03 Common Stock 91,200(2) $21.25 (D)
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Warrants Immed. 10/26/03 Common Stock 93,700(3) $21.25 (I) (4)
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</TABLE>
Explanation of Responses:
(1) These securities are owned solely by Richard and Ana Grossman JTWROS, who
are members of a "group" with Orin Hirschman for purposes of Section 13(d)
of the Exchange Act.
(2) These securities are owned solely by Orin Hirschman.
(3) The reporting persons disclaim beneficial ownership of these securities
except to the extent of their pecuniary interest therein.
(4) These securities are owned by Adam Smith Investment Partners, L.P. and
Adam Smith Investments, Ltd.
/s/ Richard Grossman 11/8/00
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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.
Page 2 of 2
<PAGE>
Joint Filer Information
Name: Orin Hirschman
Address: 101 East 52nd Street
New York, New York 10022
Designated Filer: Richard Grossman
Issuer and Ticker Symbol: Merrimac Industries, Inc. (MRM)
Date of Event Reporting Statement: 10/27/00
Signature: /s/ Orin Hirschman
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Name: Ana Grossman
Address: 101 East 52nd Street
New York, New York 10022
Designated Filer: Richard Grossman
Issuer and Ticker Symbol: Merrimac Industries, Inc. (MRM)
Date of Event Reporting Statement: 10/27/00
Signature: /s/ Ana Grossman
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