0000904454-17-000195.txt : 20170214 0000904454-17-000195.hdr.sgml : 20170214 20170214211743 ACCESSION NUMBER: 0000904454-17-000195 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170126 FILED AS OF DATE: 20170214 DATE AS OF CHANGE: 20170214 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: K2M GROUP HOLDINGS, INC. CENTRAL INDEX KEY: 0001499807 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 272977810 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 600 HOPE PARKWAY SE CITY: LEESBURG STATE: VA ZIP: 20175 BUSINESS PHONE: 703-777-3155 MAIL ADDRESS: STREET 1: 600 HOPE PARKWAY SE CITY: LEESBURG STATE: VA ZIP: 20175 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Solomon Christopher CENTRAL INDEX KEY: 0001608207 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36443 FILM NUMBER: 17612689 MAIL ADDRESS: STREET 1: C/O WELSH CARSON ANDERSON & STOWE STREET 2: 320 PARK AVENUE, SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Queally Paul B. CENTRAL INDEX KEY: 0001212993 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36443 FILM NUMBER: 17612690 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 FORMER NAME: FORMER CONFORMED NAME: QUAELLY PAUL B DATE OF NAME CHANGE: 20030106 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DENICOLA ANTHONY J CENTRAL INDEX KEY: 0001212992 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36443 FILM NUMBER: 17612691 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CARSON RUSSELL L CENTRAL INDEX KEY: 0001212986 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36443 FILM NUMBER: 17612693 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WELSH PATRICK J CENTRAL INDEX KEY: 0001212985 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36443 FILM NUMBER: 17612694 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Welsh, Carson, Anderson & Stowe XI, L.P. CENTRAL INDEX KEY: 0001437914 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36443 FILM NUMBER: 17612695 BUSINESS ADDRESS: STREET 1: C/O WELSH, CARSON, ANDERSON & STOWE STREET 2: 320 PARK AVENUE, SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 212-893-9500 MAIL ADDRESS: STREET 1: C/O WELSH, CARSON, ANDERSON & STOWE STREET 2: 320 PARK AVENUE, SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ANDERSON BRUCE K CENTRAL INDEX KEY: 0001212987 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36443 FILM NUMBER: 17612692 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2017-01-26 0001499807 K2M GROUP HOLDINGS, INC. KTWO 0001437914 Welsh, Carson, Anderson & Stowe XI, L.P. C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001212985 WELSH PATRICK J C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001212986 CARSON RUSSELL L C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001212987 ANDERSON BRUCE K C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001212992 DENICOLA ANTHONY J C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001212993 Queally Paul B. C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 1 0 1 0 0001608207 Solomon Christopher C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 Common Stock 2017-01-26 4 S 0 3926068 20.23 D 5384858 D The securities reported as directly beneficially owned by the designated Reporting Person may be deemed to be indirectly beneficially owned by each of the Reporting Owners listed below, each of whom is a managing member of the sole general partner of the designated Reporting Person. Pursuant to Instruction 4(b)(iv) of Form 4, each such individual has elected to report as indirectly beneficially owned the entire number of securities owned by the designated Reporting Person, however each of them disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. Each Reporting Owner listed below may also be deemed to indirectly beneficially own 18,147 shares of Common Stock held by WCAS XI Co-Investors LLC. Pursuant to Instruction 4(b)(iv) of Form 4, each such individual has elected to report as indirectly beneficially owned the entire number of securities owned by WCAS XI Co-Investors LLC, however each of them disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. Paul B. Queally and Sean M. Traynor each also directly beneficially own 4,439 shares of Common Stock. Part 1 of 2 /s/ David Mintz, Attorney-in-Fact 2017-02-14