-----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, VKb7/kro18kd6roYOW7DQ5oUV1p0+A+cr050GFi9PO8n4QB4ABfUQiq3qCaXeCvj L38mb60o2yZGsHVTS0aDjw== 0000912057-02-029064.txt : 20020730 0000912057-02-029064.hdr.sgml : 20020730 20020730144947 ACCESSION NUMBER: 0000912057-02-029064 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020725 FILED AS OF DATE: 20020730 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ALLIED HEALTHCARE INTERNATIONAL INC CENTRAL INDEX KEY: 0000890634 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOME HEALTH CARE SERVICES [8082] IRS NUMBER: 133098275 STATE OF INCORPORATION: NY FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-11570 FILM NUMBER: 02714626 BUSINESS ADDRESS: STREET 1: 555 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2127500064 MAIL ADDRESS: STREET 1: 555 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022 FORMER COMPANY: FORMER CONFORMED NAME: TRANSWORLD HOME HEALTHCARE INC DATE OF NAME CHANGE: 19940728 FORMER COMPANY: FORMER CONFORMED NAME: TRANSWORLD HEALTHCARE INC DATE OF NAME CHANGE: 19970610 COMPANY DATA: COMPANY CONFORMED NAME: MOSELEY FREDERICK S IV CENTRAL INDEX KEY: 0001176993 DIRECTOR STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: C/O TRIUMPH CAPITAL GROUP INC STREET 2: 28 STATE ST 37TH FL CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 6175576000 MAIL ADDRESS: STREET 1: C/O TRIUMPH CAPITAL GROUP INC STREET 2: 28 STATE ST 37TH FL CITY: BOSTON STATE: MA ZIP: 02109 3 1 a2085304z3.txt 3
- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------------- FORM 3 WASHINGTON, D.C. 20549 OMB APPROVAL - -------- ----------------------------- INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES OMB Number: 3235-0104 Expires: January 31, 2005 FILED PURSUANT TO SECTION 16(A) OF THE SECURITIES EXCHANGE ACT OF 1934, Estimated average burden SECTION 17(A) OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 OR hours per response .... 0.5 (Print or Type Responses) SECTION 30(F) OF THE INVESTMENT COMPANY ACT OF 1940 ----------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event Re- 4. Issuer Name AND Ticker or Trading Symbol quiring Statement Moseley IV Frederick S. (Month/Day/Year) Allied Healthcare International Inc. ("Allied") (f/k/a Transworld Healthcare, Inc.) ("TWH") - ------------------------------------------------- ------------------------------------------------------------ (Last) (First) (Middle) 7/25/2002 5. Relationship of Reporting Person(s) 6. If Amendment, Date ----------------------- to Issuer (Check all applicable) of Original 3. IRS or Social Se- X Director 10% Owner (Month/Day/Year) c/o Triumph Capital Group, Inc. curity Number of ---- ---- 28 State Street, 37th Floor Reporting Person Officer (give Other (specify --------------------- - ------------------------------------------------- (Voluntary) title below) below) 7. Individual or (Street) ---- ---- Joint/Group Filing (Check Applicable Line) --------------------------- Form filed by One X Reporting Person --- Form filed by More than One Reporting Person Boston MA 02109 --- - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5) (Instr. 4) (D) or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 300,000 (1) I By General Partnership (1) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) * If the form is filed by more than one reporting person, SEE Instruction 5(b)(v). SEC 1473 (02-02) POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTION OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER.
FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial Expiration (Instr. 4) Exercise Form of Ownership Date Price of Deriv- (Instr. 5) (Month/Day/ Deri- ative Year) vative Security: -------------------------------------------------- Security Direct Amount (D) or Date Expir- or Indirect Exer- ation Title Number (I) cisable Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Series A Convertible Preferred Immediately 12/17/08 Common Stock 6,627,200 (1) 1-for-1 I By General Stock Partnership - ------------------------------------------------------------------------------------------------------------------------------------ Right to Funding Note (2) Immediately None Common Stock 863,870 (1)(2) (2) I By General Partnership - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: (1) The reporting person is a shareholder of the general partners of partnerships that beneficially own the reported securities, which are owned directly by Triumph III Investors, Inc. and Triump III Advisors, Inc. The reporting person disclaims beneficial ownership of the reported securities, except to the extent of its pecuniary interest therein, which is indeterminate, and this report shall not be deemed an admission that the reporting person is the benefical owner of the securities for purposes of Sectioon 16 or any other purpose. (2) The reporting person is deemed to have acquired shares of common stock of Allied which may result from the issuance and exchange of funding notes by Allied Healthcare Group Limited ("AHG"), a U.K. subsidiary of Allied, due in satisfaction of approximately L4,953,383 of accrued and unpaid interest in kind on certain senior subordinated promissory notes issued by AHG. Each funding note is exchangeable for shares of common stock of Allied at the ratio of 0.3488 shares for every L2.00 of funding notes. /s/ Frederick S. Moseley IV 7/29/2002 ------------------------------------- ---------------------- **Frederick S. Moseley IV 7/29/2002 **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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid omb control number. SEC 1473 (02-02)
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