0001193125-14-055128.txt : 20140214 0001193125-14-055128.hdr.sgml : 20140214 20140214170359 ACCESSION NUMBER: 0001193125-14-055128 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20140214 DATE AS OF CHANGE: 20140214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FS Investment Corp III CENTRAL INDEX KEY: 0001579412 IRS NUMBER: 900994912 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-87997 FILM NUMBER: 14618341 BUSINESS ADDRESS: STREET 1: CIRA CENTRE, 2929 ARCH STREET, SUITE 675 CITY: PHILADELPHIA STATE: PA ZIP: 19104 BUSINESS PHONE: 215-495-1150 MAIL ADDRESS: STREET 1: CIRA CENTRE, 2929 ARCH STREET, SUITE 675 CITY: PHILADELPHIA STATE: PA ZIP: 19104 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: Forman Michael C. CENTRAL INDEX KEY: 0001438253 FILING VALUES: FORM TYPE: SC 13G MAIL ADDRESS: STREET 1: CIRA CENTRE STREET 2: 2929 ARCH STREET, SUITE 675 CITY: PHILADELPHIA STATE: PA ZIP: 19104-2867 SC 13G 1 d676226dsc13g.htm SCHEDULE 13G Schedule 13G

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

SCHEDULE 13G

Under the Securities Exchange Act of 1934

(Amendment No.     )*

 

 

FS INVESTMENT CORPORATION III

(Name of Issuer)

Common Stock, $0.001 par value per share

(Title of Class of Securities)

30282X 103

(CUSIP Number)

December 31, 2013

(Date of Event Which Requires Filing of this Statement)

 

 

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

¨ Rule 13d-1(b)

¨ Rule 13d-1(c)

x Rule 13d-1(d)

 

* The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page.

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

 

 

 


CUSIP No. 30282X 103   Page 2 of 6 Pages

 

  1   

Names of reporting persons

 

Michael C. Forman

  2  

Check the appropriate box if a member of a group (see instructions)

(a)  ¨        (b)  ¨

 

  3  

SEC use only

 

  4  

Citizenship or place of organization

 

    United States of America

Number of

shares

beneficially

owned by

each

reporting

person

with:

     

Sole voting power

 

    11,111.111

   6   

Shared voting power

 

    0

   7   

Sole dispositive power

 

    11,111.111

   8   

Shared dispositive power

 

    0

  9  

Aggregate amount beneficially owned by each reporting person

 

    11,111.111

10  

Check if the aggregate amount in Row (9) excludes certain shares (see instructions)    ¨

 

11  

Percent of class represented by amount in Row (9)

 

    50.0%(1)

12  

Type of reporting person (see instructions)

 

    IN

 

(1) There were 22,222.222 shares of common stock, $0.001 par value per share (“Common Stock”), of FS Investment Corporation III, a Maryland corporation (the “Issuer”), outstanding as of December 31, 2013.


Item 1.

 

  (a) Name of Issuer:

FS Investment Corporation III

 

  (b) Address of Issuer’s Principal Executive Offices:

Cira Centre

2929 Arch Street, Suite 675

Philadelphia, Pennsylvania 19104

Item 2.

 

  (a) Name of Person Filing:

Michael C. Forman

 

  (b) Address of Principal Business Office or, if None, Residence:

Cira Centre

2929 Arch Street, Suite 675

Philadelphia, Pennsylvania 19104

 

  (c) Citizenship:

Michael C. Forman is a United States citizen.

 

  (d) Title of Class of Securities:

Common stock, $0.001 par value per share

 

  (e) CUSIP Number:

30282X 103

 

Item 3. If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:

 

(a)    ¨      Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o);
(b)    ¨      Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c);
(c)    ¨      Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c);
(d)    ¨      Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C 80a-8);
(e)    ¨      An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E);
(f)    ¨      An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);
(g)    ¨      A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G);
(h)    ¨      A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);

 

Page 3 of 6 Pages


(i)    ¨      A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3);
(j)    ¨      A non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J);
(k)    ¨      A group, in accordance with §240.13d-1(b)(1)(ii)(K). If filing as a non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J), please specify the type of institution:

 

Item 4. Ownership.

Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1.

 

  (a) Amount beneficially owned: 11,111.111

 

  (b) Percent of class: 50.0%(2)

 

  (c) Number of shares as to which the person has:

 

  (i) Sole power to vote or to direct the vote: 11,111.111

 

  (ii) Shared power to vote or to direct the vote: 0

 

  (iii) Sole power to dispose or to direct the disposition of: 11,111.111

 

  (iv) Shared power to dispose or to direct the disposition of: 0

 

(2) There were 22,222.222 shares of Common Stock of the Issuer outstanding as of December 31, 2013.

 

Item 5. Ownership of Five Percent or Less of a Class.

If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following  ¨.

Not applicable.

 

Item 6. Ownership of More than Five Percent on Behalf of Another Person.

Not applicable.

 

Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company or Control Person.

Not applicable.

 

Item 8. Identification and Classification of Members of the Group.

Not applicable.

 

Page 4 of 6 Pages


Item 9. Notice of Dissolution of Group.

Not applicable.

 

Item 10. Certifications.

Not applicable.

 

Page 5 of 6 Pages


SIGNATURE

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

Dated: February 14, 2014

 

MICHAEL C. FORMAN

/s/ Michael C. Forman

 

Page 6 of 6 Pages