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OMB APPROVAL
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OMB Number: 3235-0104
Expires: September 30, 1998
Estimated average burden
hours per response ....... 0.5
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UNITED STATES 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*
DB Capital Partners, Inc.
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(Last, First Middle)
130 Liberty Street, 25th Floor
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(Street)
New York, New York 10006
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(City, State Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
May 10, 2000
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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
Computer Outsourcing Services, Inc. (COSI)
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5. Relationship of Reporting Person(s) 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)
[ X ] Form Filed by One Reporting Person
[ ] Form Filed by More than One Reporting Person
* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v)
<PAGE>
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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>
(1)
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
<PAGE>
<TABLE>
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Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<CAPTION>
3. Title and Amount of Securities
Underlying Derivative Security
2. Date Exercisable (Instr. 4)
and Expiration Date ---------------------------------
(Month/Day/Year) Amount
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Date Expira- Number
1. Title of Derivative Exer- tion of
Security (Instr. 4) cisable Date Title Shares
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<S> <C> <C> <C> <C>
(1) Series A Convertible
Preferred Stock Immed. May 10, 2007 Common Stock 786,885
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(2) Common Stock Purchase
Warrants Immed. May 10, 2007 Common Stock 1,265,963
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(3) Option to Buy Common
Stock Immed. May 10, 2007 Common Stock 375,000
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<PAGE>
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Table II (cont.) -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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5. Owner-
ship
Form of
Derivative
4. Conver- Security:
sion or Direct 6. Nature of
Exercise (D) or Indirect
Price of Indirect Beneficial
1. Title of Derivative Derivative (I) Ownership
Security (Instr. 4) Security (Instr.5) (Instr. 5)
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<S> <C> <C> <C>
(1) Series A Convertible
Preferred Stock $38.125 I DB Capital Partners,
Inc. is the General
Partner of DB Capital
Partners, L.P. which
is the General
Partner of DB
Investors, L.P. which
is the direct
beneficial owner of
the Series A
Convertible Preferred
Stock.
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(2) Common Stock Purchase
Warrants $ 0.01 I DB Capital Partners,
Inc. is the General
Partner of DB Capital
Partners, L.P. which
is the General
Partner of DB
Investors, L.P. which
is the direct
beneficial owner of
the Common Stock
Purchase Warrants.
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(3) Option to Buy Common
Stock $25.00 I DB Capital Partners, Inc.
is the General Partner
of DB Capital
Partners, L.P. which
is the General
Partner of DB
Investors, L.P. which
is the direct
beneficial owner of
the Option to Buy Common
Stock.
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</TABLE>
<PAGE>
Explanation of Responses:
DB CAPITAL PARTNERS, INC.
By: /s/ Frank Schiff
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Name: Frank L. Schiff
Title: Managing Director
5/22/00
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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 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.
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB number.
SEC 1473 (7-96)
