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 |
|
|||||||||||||||
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*
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
LIFE TIME FITNESS INC [ LTM ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
||||||||||||||||||||||||
3. Date of Earliest Transaction
(Month/Day/Year) 07/06/2004 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
|
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 | 07/06/2004 | C | 3,189,329 | A | (1) | 8,025,327 | D(2) | |||
Common Stock | 07/06/2004 | C | 312,500 | A | (1) | 8,337,827 | D(2) | |||
Common Stock | 07/06/2004 | S | 1,561,000 | D | $18.5 | 6,776,827 | D(2) | |||
Common Stock | 07/06/2004 | C | 914,285 | A | (1) | 944,758 | I | By limited partnership(3) | ||
Common Stock | 07/06/2004 | C | 1,250,000 | A | (1) | 1,250,000 | I | By limited partnership(4) | ||
Common Stock | 07/06/2004 | C | 312,500 | A | (1) | 1,562,500 | I | By limited partnership(4) |
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 | ||||||||
Series B Convertible Preferred Stock | (5) | 07/06/2004 | C | 697,666 | 06/29/2004 | (1) | Common Stock | 3,189,329 | $0 | 0 | D(2) | ||||
Series D Convertible Preferred Stock | (6) | 07/06/2004 | C | 250,000 | 06/29/2004 | (1) | Common Stock | 312,500 | $0 | 0 | D(2) | ||||
Series B Convertible Preferred Stock | (5) | 07/06/2004 | C | 800,000 | 06/29/2004 | (1) | Common Stock | 914,285 | $0 | 0 | I | By limited partnership(3) | |||
Series C Convertible Preferred Stock | (7) | 07/06/2004 | C | 1,000,000 | 06/29/2004 | (1) | Common Stock | 1,250,000 | $0 | 0 | I | By limited partnership(4) | |||
Series D Convertible Preferred Stock | (6) | 07/06/2004 | C | 250,000 | 06/29/2004 | (1) | Common Stock | 312,500 | $0 | 0 | I | By limited partnership(4) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
|
Explanation of Responses: |
1. Not applicable. |
2. The securities reported on Lines 1 through 3 of Table I and on Lines 1 and 2 of Table II are held of record by Norwest Equity Partners V, LP ("NEP V"), a limited partnership, of which Itasca Partners V, L.L.P. ("Itasca V") is the general partner. John E. Lindahl and George J. Still, Jr., are the managing partners and John P. Whaley is the managing administrative partner of Itasca V. Each of Itasca V and Messrs. Lindahl, Still and Whaley disclaims any beneficial interest in such securities, except to the extent of its or his indirect pecuniary interest therein. |
3. The securities reported on Line 3 of Table I and Line 3 of Table II are held of record by Norwest Equity Partners VI, LP ("NEP VI"), a limited partnership, of which Itasca LBO Partners VI, LLP ("Itasca VI") is the general partner. John E. Lindahl is the managing partner and John P. Whaley is the managing administrative partner of Itasca VI. Each of Itasca VI and Messrs. Lindahl and Whaley disclaims any beneficial interest in such securities, except to the extent of its or his indirect pecuniary interest therein. |
4. The securities reported on Lines 5 and 6 of Table I and Lines 4 and 5 of Table II are held of record by Norwest Equity Partners VII, LP ("NEP VII"), a limited partnership, of which Itasca LBO Partners VII, LLP ("Itasca VII") is the general partner. John E. Lindahl is the managing partner and John P. Whaley is the managing administrative partner and of Itasca VII. Each of Itasca VII and Messrs. Lindahl and Whaley disclaims any beneficial interest in such securities, except to the extent of its or his indirect pecuniary interest therein. |
5. Each share of Series B Preferred Stock converted into 4.571428 shares of Issuer's common stock in connection with its initial public offering. |
6. Each share of Series D Preferred Stock ("Series D") converts into one share of Issuer's common stock. In connection with its initial public offering, each share of Series D converted into 1.25 shares of Issuer's common stock. |
7. Each share of Series C Preferred Stock ("Series C") converts into one share of Issuer's common stock. In connection with its initial public offering, each share of Series C converted into 1.25 shares of Issuer's common stock. |
Remarks: |
John P. Whaley, Managing Administrative Partner of Itasca Partners V, L.L.P., for itself and as General Partner of Norwest Equity Partners V, LP, a Minnesota limited partnership | 07/09/2004 | |
John P. Whaley | 07/09/2004 | |
John E. Lindahl | 07/09/2004 | |
George J. Still, Jr. | 07/09/2004 | |
** 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). | ||
** 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. |