SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
KOEPFGEN BRUCE L

(Last) (First) (Middle)
LIBERTY LANE

(Street)
HAMPTON NH 03842

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FISHER SCIENTIFIC INTERNATIONAL INC [ FSH ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/09/2006
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/09/2006 D 2,000 D (1) 0 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) $60.07(2) 11/09/2006 D 10,000 (2) 05/06/2015 Common Stock 10,000 (2) 0 D
Employee Stock Option (right to buy) $73.73(2) 11/09/2006 D 10,000 (2) 05/05/2016 Common Stock 10,000 (2) 0 D
Explanation of Responses:
1. Each Restricted Stock Unit accrued under the issuer's 2005 Equity and Incentive Plan is the economic equivalent of one share of issuer common stock. The Restricted Stock Units were settled pursuant to the Agreement and Plan of Merger between Thermo Electron Corporation, Trumpet Merger Corporation and the issuer (the "Merger Agreement") for 2.0 shares of common stock of the surviving entity, Thermo Fisher Scientific Inc. ("Thermo Fisher"), on November 9, 2006, the effective date of the merger. Thermo Fisher stock had a market value of $45.03 per share on November 10, 2006, the first day Thermo Fisher stock was traded following the effective date of the merger.
2. This option (the "Original Option") was assumed by Thermo Fisher under the Merger Agreement and replaced with an option to purchase shares of Thermo Fisher common stock ("Substitute Option"). Under the Substitute Option: the number of option shares will equal the number of option shares under the Original Option, times the Exchange Ratio; and the exercise price will equal the exercise price under the Original Option, divided by the Exchange Ratio. The Exchange Ratio is 2.0.
Remarks:
/s/ Bruce L. Koepfgen 11/13/2006
** 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 4 (b)(v).
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