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*
Waters Richard D.
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(Last) (First) (Middle)
c/o Chase Capital Partners
380 Madison Avenue-12th Floor
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(Street)
New York New York 10017
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(City) (State) (Zip)
10/20/99
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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)
NuCo2, Inc. ("NUCO")
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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)
10/ /99
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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 -0- N/A N/A
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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>
Warrants Immed 10/31/04 Common Stock 327,869 $6.65 I (FN 1)
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Warrants Immed 10/31/05 Common Stock 323,173 $6.65 I (FN 1)
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Common Stock
(Option to Purchase)
(FN 2) (FN 3) 10/02/09 Common Stock 6,000 $7.25 D
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</TABLE>
Explanation of Responses:
(1) The amount shown represents the beneficial ownership of the Issuer's
securities by Chase Equity Associates, LP ("CEA, LP"), a portion of which
may be deemed attributable to the reporting person because the reporting
person is a partner of Chase Capital Partners ("CCP"), which is the
general partner and manager of CEA, LP. 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 CEA, LP'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.
(2) The Option was granted to the reporting person. As a partner of CCP,
Mr. Waters is contractually obligated to exercise the option at the
request of, and to transfer any shares issued under the option to CEA, LP.
(3) One third of the number of shares subject to the option are exercisable
commencing October 20, 2000, one-third of the number of shares subject to
the option are exercisable commencing on October 20, 2001 and the
final one-third of the number of shares subject to the option are
exercisable commencing October 20, 2002.
/s/ Richard D. Waters 6/9/00
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Richard D. Waters 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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