U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
[_] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
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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
1221 Avenue of the Americas-40th Floor
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(Street)
New York New York 10020
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(City) (State) (Zip)
NuCo2, Inc. ("NUCO")
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2. Issuer Name and Ticker or Trading Symbol
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
May 2000
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4. Statement for Month/Year
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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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 Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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</TABLE>
* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
(Over)
(Form 4-07/99)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr.(Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Options (right
to purchase) Common
(FN 1) $7.25 N/A N/A N/A N/A N/A (FN 2) 10/02/09 Stock 6,000 N/A 6,000 D
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Common
Warrants $6.65 N/A N/A N/A N/A N/A Immed. 10/31/04 Stock 327,869 N/A 651,042 I (FN 3)
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Common
Warrants $6.65 N/A N/A N/A N/A N/A Immed. 10/31/05 Stock 323,173 N/A 651,042 I (FN 3)
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Convertible
Preferred Common
Stock $9.47 5/15/00 P N/A 527,983.10 Immed. N/A Stock 527,983.10 N/A 527,983.10 I (FN 3)
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</TABLE>
Explanation of Responses:
(1) The option was granted to the reporting person. As a partner of the
General Partner of Chase Capital Investments, LP ("CCI"), Mr. Waters is
contractually obligated to exercise the option at the request of, and
to transfer any shares issued under the stock option to, CCI.
(2) One-third of the number of shares subject to the option are exercisable
commencing on 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 on October 20, 2002.
(3) Prior to May 12, 2000, these securities were owned by Chase Equity
Associates, LP ("CEA, LP"), which became a limited liability company as
of January 1, 2000, and reverted to a limited partnership form of
organization as of March 13, 2000. On May 12, 2000, CEA, LP transferred
the warrants to its affiliate, CCI. The reporting person is a partner of
Chase Capital Partners ("CCP"), the general partner of CEA, LP and CCI.
The actual pro rata portion of the beneficial ownership of the Issuer's
securities that may be deemed to be attributable to the reporting person
as a partner of CCP is not readily determinable because it is subject to
several variables, including the internal rate of return and vesting of
interests within CCP and CCI. The reporting person disclaims beneficial
ownership of the securities to the extent it exceeds his pecuniary interest
therein.
/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.
