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*
NORWEST EQUITY PARTNERS V LP

(Last) (First) (Middle)
C/O NORWEST EQUITY PARTNERS
3600 IDS CENTER, 80 SOUTH EIGHTH STREET

(Street)
MINNEAPOLIS MN 55402

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
LIFE TIME FITNESS INC [ LTM ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
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)
Form filed by One Reporting Person
X 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 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*
NORWEST EQUITY PARTNERS V LP

(Last) (First) (Middle)
C/O NORWEST EQUITY PARTNERS
3600 IDS CENTER, 80 SOUTH EIGHTH STREET

(Street)
MINNEAPOLIS MN 55402

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
ITASCA PARTNERS V LLP

(Last) (First) (Middle)
C/O NORWEST EQUITY PARTNERS
3600 IDS CENTER, 80 SOUTH EIGHTH STREET

(Street)
MINNEAPOLIS MN 55402

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
LINDAHL JOHN E

(Last) (First) (Middle)
C/O NORWEST EQUTIY PARTNERS
3600 IDS CENTER, 80 SOUTH EIGHTH STREET

(Street)
MINNEAPOLIS MN 55402

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
STILL GEORGE J JR

(Last) (First) (Middle)
C/O NORWEST VENTURE PARTNERS
525 UNIVERSITY AVENUE, SUITE 800

(Street)
PALO ALTO CA 94301

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WHALEY JOHN P

(Last) (First) (Middle)
3600 IDS CENTER
80 SOUTH EIGHTH STREET

(Street)
MINNEAPOLIS MN 55402

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
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).
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