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OMB Number: 3235-0104
Expires: January 31, 2005
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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(h) of the Investment Company Act of 1940
(Print of Type Responses)
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1. Name and Address of Reporting Person*
Gaines-Cooper Robert
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(Last) (First) (Middle)
10115 Kincey Avenue, Suite 250
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(Street)
Huntersville, N.C. 28078
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
01/02/03
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3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Orthofix International N.V. ("OFIX")
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|X| Director |_| 10% Owner
|X| Officer (give title below) |_| Other (specify below)
Chairman
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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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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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Common Stock 300,000 D
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Common Stock 718,000(1) I By Bird Island Trust
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Common Stock 220,000(1) I By LMA International S.A.
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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).
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
control number.
(Over)
SEC 147 (7-02)
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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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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Stock Option (right to buy) (2) 3/31/03 Common Stock 275,000 $14.40 D
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Stock Option (right to buy) (2) 1/1/09 Common Stock 100,000 $17.875 D
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Stock Option (right to buy) (3) 1/1/09 Common Stock 87,500 $17.875 D
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Explanation of Responses:
(1) The Reporting Person disclaims beneficial ownership of these securities
except to the extent of his pecuniary interest therein, and this report
shall not be deemed an admission that the Reporting Person is the
beneficial owner of such securities for purposes of Section 16 of the
Securities Exchange Act of 1934, as amended, or for any other purposes.
(2) The option is currently exercisable.
(3) The option vests on the earlier of January 1, 2004 or the date on which the
closing price of OFIX's Common Stock is $55 or higher consecutively for ten
trading days immediately prior to such date.
/s/ Robert Gaines-Cooper 1/10/03
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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.
Potentional 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.
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