-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Db5tNEJawVVKaxArDEt3Qgu8eP6Y9kOhBxcyugRtF/fe1Gig8x3P57S8uzNO0Zts pV8JJWurwhpl5BHCDaMDSg== 0000950137-05-001507.txt : 20050210 0000950137-05-001507.hdr.sgml : 20050210 20050210151320 ACCESSION NUMBER: 0000950137-05-001507 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20050210 DATE AS OF CHANGE: 20050210 GROUP MEMBERS: MICHAEL J. JANDERNOA TRUST SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PERRIGO CO CENTRAL INDEX KEY: 0000820096 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 382799573 STATE OF INCORPORATION: MI FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-41985 FILM NUMBER: 05592635 BUSINESS ADDRESS: STREET 1: 515 EASTERN AVENUE CITY: ALLEGAN STATE: MI ZIP: 49010 BUSINESS PHONE: 6166738451 MAIL ADDRESS: STREET 1: 515 EASTERN AVENUE CITY: ALLEGAN STATE: MI ZIP: 49010 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: JANDERNOA MICHAEL J CENTRAL INDEX KEY: 0001024511 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] STATE OF INCORPORATION: MI FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: C/O PERRIGO CO STREET 2: 333 BRIDGE ST. N.W. #800 CITY: GRAND RAPIDS STATE: MI ZIP: 49504 BUSINESS PHONE: 6167321771 MAIL ADDRESS: STREET 1: C/O PERRIGO CO STREET 2: 333 BRIDGE STREET NW, SUITE 800 CITY: GRAND RAPIDS STATE: MI ZIP: 49504 SC 13G/A 1 c92063a4sc13gza.txt AMENDMENT TO SCHEDULE 13G CUSIP NO. 714290103 13G/A PAGE 1 OF 7 PAGES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G/A Information to be included in Statements filed pursuant to Rules 13d-1(b), (c), and (d) and Amendments thereto filed pursuant to Rule 13d-2(b) (Amendment No. 4)(1) PERRIGO COMPANY (Name of Issuer) Common Stock, without par value (Title of Class of Securities) 714290103 (CUSIP Number) December 31, 2004 (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) [X] Rule 13d-1(c) [ ] Rule 13d-1(d) (1) 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 the disclosures provided in a prior cover page. The information required on 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). Page 1 of 7 Pages No Exhibit Index CUSIP NO. 714290103 13G/A PAGE 2 OF 7 PAGES - -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Michael J. Jandernoa - -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [ ] - -------------------------------------------------------------------------------- 3 SEC USE ONLY - -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States - -------------------------------------------------------------------------------- 5 SOLE VOTING POWER 6,048,763 ----------------------------------------------------------------- NUMBER OF 6 SHARED VOTING POWER SHARES BENEFICIALLY 0 OWNED BY ----------------------------------------------------------------- EACH 7 SOLE DISPOSITIVE POWER REPORTING PERSON 6,048,763 WITH ----------------------------------------------------------------- 8 SHARED DISPOSITIVE POWER 0 - -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 6,524,953 - -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 9.1% - -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* IN - -------------------------------------------------------------------------------- * SEE INSTRUCTION BEFORE FILLING OUT! ** SEE ITEM 4 OF THIS FILING CUSIP NO. 714290103 13G/A PAGE 3 OF 7 PAGES - -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Michael J. Jandernoa Trust - -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [ ] - -------------------------------------------------------------------------------- 3 SEC USE ONLY - -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION Michigan - -------------------------------------------------------------------------------- 5 SOLE VOTING POWER 5,891,305 ----------------------------------------------------------------- NUMBER OF 6 SHARED VOTING POWER SHARES BENEFICIALLY 0 OWNED BY ----------------------------------------------------------------- EACH 7 SOLE DISPOSITIVE POWER REPORTING PERSON 5,891,305 WITH ----------------------------------------------------------------- 8 SHARED DISPOSITIVE POWER 0 - -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 5,891,305 - -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 8.2% - -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* OO--Trust - -------------------------------------------------------------------------------- * SEE INSTRUCTION BEFORE FILLING OUT! ** SEE ITEM 4 OF THIS FILING CUSIP NO. 714290103 13G/A PAGE 4 OF 7 PAGES ITEM 1. (a) Name of Issuer: Perrigo Company (b) Address of Issuer's Principal Executive Offices: 515 Eastern Avenue Allegan, Michigan 49010 ITEM 2. (a)-(c) Name, Principal Business Address and Citizenship of Person Filing: Michael J. Jandernoa c/o Law Weathers & Richardson 333 Bridge Street, NW, Suite 800 Grand Rapids, Michigan 49504 Citizenship: United States (d) Title of Class of Securities: Common Stock, without par value. (e) CUSIP Number: 714290103 ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D-1(B), OR 13D-2(B) OR (C), CHECK WHETHER THE PERSON FILING IS A: (a)-(j) Not Applicable. ITEM 4. OWNERSHIP (a) Mr. Jandernoa is the beneficial owner of 6,524,953 shares of the Issuer's common stock, without par value. Mr. Jandernoa owns 2,191 shares of the Issuer's common stock. The Michael J. Jandernoa Trust, of which Mr. Jandernoa is the sole trustee, holds 5,891,305 shares of the Issuer's common stock. The Michael J. Jandernoa Grantor Trust 2, of which Mr. Jandernoa is the sole trustee and has a reversionary interest, holds 136,986 shares of the Issuer's common stock. Mr. Jandernoa holds sole voting and dispositive power in both the Michael J. Jandernoa Trust and the Michael J. Jandernoa Grantor Trust 2. The Susan M. Jandernoa Trust holds 339,204 shares of the Issuer's common stock. Mrs. Jandernoa is the sole trustee and holds sole voting and dispositive power for the shares of common stock held by the Susan M. Jandernoa Trust. The Susan M. Jandernoa Grantor Trust 2 holds 136,986 shares of the Issuer's common stock. Mrs. Jandernoa is the sole trustee and holds sole voting and dispositive power for the shares of common stock held by the Susan M. Jandernoa Grantor Trust 2. Mr. Jandernoa holds stock options that give him the right to acquire 18,281 shares of the Issuer's common stock within 60 days of the date of this filing. The figures above are as of December 31, 2004. CUSIP NO. 714290103 13G/A PAGE 5 OF 7 PAGES On November 14, 2004, Mr. Jandernoa entered into a Voting Agreement with Agis Industries (1983) Ltd., an Israeli public company ("Agis") pursuant to which Mr. Jandernoa agreed to vote all shares of Issuer's common stock owned by him on the date of the vote in favor of the issuance of Issuer common stock contemplated in the merger of one of Issuer's subsidiaries with and into Agis (the "Share Issuance"). In addition, pursuant to the Voting Agreement, Mr. Jandernoa has executed and delivered to Agis an irrevocable proxy to vote all shares owned by him in favor of the Share Issuance. As a result of the Voting Agreement and the related proxy, Mr. Jandernoa has no voting power with respect to the Share Issuance, but he retains voting power with respect to all other matters. The Voting Agreement does not affect Mr. Jandernoa's dispositive power. (b) As of December 31, 2004, Mr. Jandernoa was the beneficial owner of 9.1% of the Issuer's outstanding common stock, without par value. The Issuer's most recent Form 10-Q (for the quarterly period ended December 25, 2004) lists 71,562,269 shares of the Issuer's common stock, outstanding as of January 25, 2005. In addition, Mr. Jandernoa holds stock options, which give him the right to acquire 18,281 shares of the Issuer's common stock within 60 days of the date of this filing. Mr. Jandernoa's beneficial ownership percentage is based on a total of 71,580,550 shares of the Issuer's common stock, which consists of the Issuer's outstanding common stock plus shares that would become outstanding if Mr. Jandernoa exercised his stock options. As of December 31, 2004, the Michael J. Jandernoa Trust held 8.2% of the Issuer's outstanding common stock, without par value. The beneficial ownership percentage of the Michael J. Jandernoa Trust is based on the Issuer's 71,562,269 shares of common stock outstanding as of January 25, 2005. (c) (i) Mr. Jandernoa has sole power to vote or direct the vote of 6,048,763 shares of common stock. (ii) Mr. Jandernoa does not share power to vote or to direct the vote of any shares of common stock. (iii) Mr. Jandernoa has sole power to dispose or direct the disposition of 6,048,763 shares of common stock. (iv) Mr. Jandernoa does not share power to dispose or to direct the disposition of any shares of common stock. ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS Not Applicable. ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON The Michael J. Jandernoa Trust, of which Mr. Jandernoa is the trustee, holds 5,891,305 shares of the Issuer's common stock. CUSIP NO. 714290103 13G/A PAGE 6 OF 7 PAGES ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY Not Applicable. ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP Not Applicable. ITEM 9. NOTICE OF DISSOLUTION OF GROUP Not Applicable. ITEM 10. CERTIFICATION By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect. CUSIP NO. 714290103 13G/A PAGE 7 OF 7 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. February 10, 2005 ---------------------------------------- Date /s/ Michael J. Jandernoa ---------------------------------------- Signature /s/ Michael J. Jandernoa ---------------------------------------- As trustee of the Michael J. Jandernoa Trust and in his individual capacity -----END PRIVACY-ENHANCED MESSAGE-----