SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES 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
or Section 30(h) of the Investment Company Act of 1940
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
|
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1. Name and Address of Reporting Person*
| SEARS TOWER, 92ND FLOOR |
| 22 SOUTH WACKER DRIVE |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
05/31/2007
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3. Issuer Name and Ticker or Trading Symbol
JAZZ PHARMACEUTICALS INC
[ JAZZ ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
X |
10% Owner |
|
Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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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 |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Series B Preferred Stock |
|
|
Common Stock |
1,987,942 |
0
|
I |
See footnote
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1. Name and Address of Reporting Person*
| SEARS TOWER, 92ND FLOOR |
| 22 SOUTH WACKER DRIVE |
(Street)
|
1. Name and Address of Reporting Person*
| SEARS TOWER, 92ND FLOOR |
| 22 SOUTH WACKER DRIVE |
(Street)
|
1. Name and Address of Reporting Person*
| SEARS TOWER, 92ND FLOOR |
| 22 SOUTH WACKER DRIVE |
(Street)
|
1. Name and Address of Reporting Person*
| C/O THOMA CRESSEY BRAVO, SEARS TOWER |
| 92ND FLOOR, 22 SOUTH WALKER DRIVE |
(Street)
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| Explanation of Responses: |
|
|
|
| Remarks: |
|
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/s/ Bryan C. Cressey for THOMA CRESSEY BRAVO, INC. |
05/31/2007 |
|
/s/ Bryan C. Cressey for THOMA CRESSEY FUND VII, L.P. |
05/31/2007 |
|
/s/ Bryan C. Cressey for THOMA CRESSEY FRIENDS FUND VII, L.P. |
05/31/2007 |
|
/s/ Bryan C. Cressey |
05/31/2007 |
|
** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
| ** 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. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
rrd141867_160305.html
Exhibit 99
FORM 3 JOINT FILER INFORMATIONName of
"Reporting Persons": Thoma Cressey Bravo, Inc.
Thoma Cressey Fund VII, LP
; Thoma Cressey Friends Fund VII, LP
Bryan C. Cressey
Address: Sears Tower, 92nd Floor, 22 South Wacker Drive, Chicago, IL 60606
Designated Filer: Thoma Cressey Bravo, Inc.
Issuer and Ticker Symbol: Jazz Pharmaceuticals, Inc. (JAZZ)
Date of Event: May 31, 20
07
The nature of indirect beneficial ownership is as follows: Bryan C. Cressey, Orlando Bravo, Lee Mitchell
and Carl Thoma are partners of Thoma Cressey Bravo, Inc., which is the general partner of each of
Thoma Cressey Fund VII, LP and Thoma Cressey Friends Fund VII, LP., or the Thoma Cressey Funds,
and are deemed to have shared voting and investment power over the shares held by the Thoma Cressey
Funds. Each of Messrs. Cressey, Bravo, Mitchell and Thoma disclaim beneficial ownership of the shares
held by the Thoma Cressey Funds, except to the extent of each of their pecuniary interest therein.
Pursuant to Instruction (5)(b)(iv) of Form 3, the Reporting Persons have elected to report as indirectly
beneficially owned the entire number of securities beneficially owned by such corporation. The
Reporting Persons disclaims beneficial ownership of any securities, and proceeds thereof, that exceed his
or her pecuniary interest therein, and/or that are not actually distri
buted to him or her.
The filing of this statement shall not be deemed an admission that, for purposes of Section 16 of the
Securities Exchange Act of 1934, or otherwise, any of the Reporting Persons are the beneficial owners of
all of the equity securities covered by this statement.
Each of the Reporting Persons listed above hereby designates Thoma Cressey Bravo, Inc. as its
designated filer of Forms 3, 4 and 5 in accordance with Section 16(a) of the Securities Exchange Act of
1934 and the rules thereunder. Each Reporting Person hereby appoints Bryan C. Cressey as its attorney
in fact for the purpose of making reports relating to transactions in Jazz Pharmaceuticals, Inc. Common
Stock.
THOMA CRESSEY BRAVO, INC.
By: /s/ Bryan C. Cressey
Bryan Cressey
Partner
THOMA CRESSEY FUND VII, L.P.
By: /s/ Bryan C. Cressey
; Bryan Cressey
Partner
THOMA CRESSEY FRIENDS
FUND VII, L.P.
By: /s/ Bryan C. Cressey
Bryan Cressey
Partner
/s/ Bryan C. Cressey
Bryan C. Cressey
