-----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, P5hy+EkwWZIT/PnsB98VrnQRXVO8kwg9VP8jIpXaX/pXxljJvS+ZMTcT7O/ZFRaU wdVhc1pszk8Vl/Sp4ouF7Q== 0000950136-02-003144.txt : 20021112 0000950136-02-003144.hdr.sgml : 20021111 20021112082355 ACCESSION NUMBER: 0000950136-02-003144 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021104 FILED AS OF DATE: 20021112 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: BERGERON DANIEL A CENTRAL INDEX KEY: 0001204696 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: ALLIED HEALTHCARE INTERNATIONAL INC STREET 2: 555 MADISON AVE. CITY: NEW YORK STATE: NY ZIP: 10022 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: 02815150 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 3 1 file001.txt FORM 3 FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES FILED PURSUANT TO SECTION 16(a) OF THE SECURITIES EXCHANGE ACT OF 1934, SECTION 17(a) OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 OR SECTION 30(h) OF THE INVESTMENT COMPANY ACT OF 1940 - -------------------------------------------------------------------------------- 1. NAME AND ADDRESS OF REPORTING PERSON* Bergeron Daniel A. - -------------------------------------------------------------------------------- (LAST) (FIRST) (MIDDLE) c/o Allied Healthcare International Inc. 555 Madison Ave. - -------------------------------------------------------------------------------- (STREET) New York New York 10022 - -------------------------------------------------------------------------------- (CITY) (STATE) (ZIP) - -------------------------------------------------------------------------------- 2. DATE OF EVENT REQUIRING STATEMENT (MONTH/DAY/YEAR) Nov. 4, 2002 - -------------------------------------------------------------------------------- 3. I.R.S. OR SOCIAL SECURITY NUMBER OF REPORTING PERSON, IF AN ENTITY (VOLUNTARY) - -------------------------------------------------------------------------------- 4. ISSUER NAME AND TICKER OR TRADING SYMBOL Allied Healthcare International Inc. (ADH) - -------------------------------------------------------------------------------- 5. RELATIONSHIP OF REPORTING PERSON(S) TO ISSUER (CHECK ALL APPLICABLE) |_| DIRECTOR |_| 10% OWNER |X| OFFICER (GIVE TITLE BELOW) |_| OTHER (SPECIFY BELOW) CHIEF FINANCIAL OFFICER -------------------------------------------------------------------- - -------------------------------------------------------------------------------- 6. IF AMENDMENT, DATE OF ORIGINAL (MONTH/DAY/YEAR) - -------------------------------------------------------------------------------- 7. INDIVIDUAL OR JOINT/GROUP FILING (CHECK APPLICABLE LINE) |X| FORM FILED BY ONE REPORTING PERSON |_| FORM FILED BY MORE THAN ONE REPORTING PERSON
==================================================================================================================================== TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED ==================================================================================================================================== 3. OWNERSHIP FORM: 2. AMOUNT OF SECURITIES DIRECT (D) OR 1. TITLE OF SECURITY BENEFICIALLY OWNED INDIRECT (I) 4. NATURE OF INDIRECT BENEFICIAL OWNERSHIP (INSTR. 4) (INSTR. 4) (INSTR. 5) (INSTR. 4) - ------------------------------------------------------------------------------------------------------------------------------------ No securities are beneficially owned - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== * IF THE FORM IS FILED BY MORE THAN ONE REPORTING PERSON, SEE INSTRUCTION 5(b)(v). REMINDER: REPORT ON A SEPARATE LINE FOR EACH CLASS OF SECURITIES BENEFICIALLY OWNED DIRECTLY OR INDIRECTLY. (OVER) SEC 1473 (9/96)
FORM 3 (CONTINUED)
TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ==================================================================================================================================== 5. OWNER- 3. TITLE AND AMOUNT OF SECURITIES SHIP UNDERLYING DERIVATIVE SECURITY FORM OF 2. DATE EXERCISABLE (INSTR. 4) DERIVATIVE AND EXPIRATION DATE --------------------------------- 4. CONVER- SECURITY: (MONTH/DAY/YEAR) AMOUNT SION OR DIRECT 6. NATURE OF ---------------------- OR EXERCISE (D) OR INDIRECT DATE EXPIRA- NUMBER PRICE OF INDIRECT BENEFICIAL 1. TITLE OF DERIVATIVE EXER- TION OF DERIVATIVE (I) OWNERSHIP SECURITY (INSTR. 4) CISABLE DATE TITLE SHARES SECURITY (INSTR. 5) (INSTR. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
EXPLANATION OF RESPONSES: /S/ DANIEL A. BERGERON NOVEMBER 4, 2002 ------------------------------- ---------------- **SIGNATURE OF REPORTING PERSON DATE ** INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS CONSTITUTE FEDERAL CRIMINAL VIOLATIONS. PAGE 2 SEE 18 U.S.C. 1001 AND 15 U.S.C. 78ff(a). -----END PRIVACY-ENHANCED MESSAGE-----