FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 03/14/2012 |
3. Issuer Name and Ticker or Trading Symbol
M/A-COM Technology Solutions Holdings, Inc. [ MTSI ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Class B Convertible Preferred Stock | 12/21/2010 | (1) | Common Stock | 33,884,814(3) | (1) | D | |
Warrants | 12/21/2010 | (2) | Common Stock | 5,082,722(4) | 3.51 | D |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. The Class B Convertible Preferred Stock is convertible into M/A-COM Technology Solutions Holdings, Inc. common stock on the closing date of the initial public offering ("IPO") registered on March 14, 2012 and has no expiration date. |
2. The Warrants are convertible into M/A-COM Technology Solutions Holdings, Inc. common stock and have no expiration date. |
3. The Convertible Class B Preferred Stock is held as follows: 21,132,108 in the name of Summit Partners Private Equity Fund VII-A, L.P.; 12,692,284 in the name of Summit Partners Private Equity Fund VII-B, L.P.; 56,436 in the name of Summit Investors I, LLC; 3,986 in the name of Summit Investors I (UK), L.P. The Class B Convertible Preferred Stock will be spilt on a one for four basis effective on the closing date of the IPO. |
4. The rights to purchase common stock shares are held as follows: 3,169,816 in the name of Summit Partners Private Equity Fund VII-A, L.P.; 1,903,843 in the name of Summit Partners Private Equity Fund VII-B, L.P.; 8,465 in the name of Summit Investors I, LLC; 598 in the name of Summit Investors I (UK), L.P. The rights to purchase common stock shares will be spilt on a one for four basis effective on the closing date of the IPO. |
Remarks: |
The entities mentioned in Footnote 3 and 4 are collectively referred to as the "Summit Entities." Each of the Summit Entities disclaims beneficial ownership of the shares except for those listed in the Footnoes as held by such entity, except to the extent of each such entity's pecuniary interest therein. |
Summit Partners Private Equity Fund VII-A, L.P., by Summit Partners PE VII, L.P., its GP, by Summit Partners PE VII, LLC, its GP, by Summit Partners, L.P., its GP, by Summit Master Company, LLC, its GP, by Robin W. Devereux, POA for Joseph Trustey, Member | 03/14/2012 | |
Summit Partners Private Equity Fund VII-B, L.P., by Summit Partners PE VII, L.P., its GP, by Summit Partners PE VII, LLC, its GP, by Summit Partners, L.P., its GP, by Summit Master Company, LLC, its GP, by Robin W. Devereux, POA for Joseph Trustey, Member | 03/14/2012 | |
Summit Investors I, LLC, by Summit Investors Management, LLC, its manager, by Summit Partners, L.P., its managing member, by Summit Master Company, LLC, its general partner, by Robin W. Devereux, POA for Joseph F. Trustey, Member | 03/14/2012 | |
Summit Partners Private Equity Fund VII-A, L.P., by Summit Partners PE VII, L.P., its GP, by Summit Partners PE VII, LLC, its GP, by Summit Partners, L.P., its GP, by Summit Master Company, LLC, its GP, by Robin W. Devereux, POA for Joseph Trustey, Member | 03/14/2012 | |
** 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 5 (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. |
(a)
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Sections 13 and 16 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), Rule 144 promulgated under the Securities Act of 1933, as amended (the “33 Act”) and any and all regulations promulgated thereunder, including filings with the Securities and Exchange Commission pursuant thereto;
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(b)
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any written ballot or proxy with respect to any investment securities owned beneficially or of record by any such entities;
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(c)
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such filings required pursuant to the Internal Revenue Code of 1986, as amended, and any related regulations, pertaining to such entities
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(d)
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economic exhibits relating to such entities; and
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(e)
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the PATRIOT Act.
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HKL I Partners
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Summit Accelerator Management, LLC
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HKL I, LLC
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Summit Accelerator Management, L.P.
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SD II Bennington Blocker Corp.
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Summit Accelerator Partners, LLC
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SD II Eyeglass Blocker Corp.
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Summit Accelerator Partners, L.P.
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SD II Eyeglass Holdings, L.P.
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Summit Founders' Fund II, L.P.
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SD III-B Nomacorc Blocker Corp.
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Summit Founders' Fund, L.P.
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SD III-B Nomacorc Holdings, L.P.
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Summit GmbH & Co. Beteiligungs KG
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SD III-B Tippmann Blocker Corp.
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Summit Incentive Plan II, L.P.
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SD III-B Tippmann Holdings, L.P.
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Summit Incentive Plan, L.P.
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SD III-B Tivoli Blocker Corp.
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Summit Investment Holdings Trust
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SD III-B Tivoli Holdings, L.P.
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Summit Investment Holdings Trust II
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SD III-B TUI Blocker Corp.
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Summit Investors (SAF) IV, L.P.
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SD III-B TUI Holdings, L.P.
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Summit Investors Holdings Trust
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SDIII-B Focus Blocker Corp.
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Summit Investors I (UK), L.P.
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SDIII-B Focus Holdings, L.P.
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Summit Investors I, LLC
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Shearson Summit Partners Management, L.P.
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Summit Investors II, L.P.
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SP (1984), L.P.
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Summit Investors III, L.P.
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SP PE VII-B Announce Blocker Corp.
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Summit Investors Management, LLC
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SP PE VII-B Announce Holdings, L.P.
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Summit Investors VI, L.P.
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SP PE VII-B Nomacorc Holdings, L.P.
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Summit Investors, L.P.
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SP VC II-B TMFS Blocker Corp.
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Summit LogistiCare LLC
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SP VC II-B TMFS Holdings, L.P.
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Summit Master Company, LLC
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Sparta Holding Corporation
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Summit Partners III S.a.r.l.
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SPPE VII-B Aurora Blocker Corp.
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Summit Partners PE VII, LLC
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SPPE VII-B Aurora Holdings, L.P.
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Summit Partners PE VII, L.P.
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SPPE VII-B CD Blocker Corp.
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Summit Partners Blocker, Inc.
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SPPE VII-B Champion Blocker Corp.
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Summit Partners Europe Private Equity Fund, L.P.
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SPPE VII-B Nomacorc Blocker Corp.
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Summit Partners Europe, L.P.
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SPPE VII-B SUN Blocker Corp.
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Summit Partners Europe, LTD.
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SPPE VII-B SUN Holdings, L.P.
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Summit Partners F.F. Corp.
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SPPE VII-B TUI Blocker Corp.
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Summit Partners Holdings, L.P.
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SPPE VII-B TUI Holdings, L.P.
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Summit Partners II S.a.r.l.
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SPVCII-B Anesthetix Blocker Corp.
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Summit Partners II, L.P.
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SPVCII-B LiveOffice Blocker Corp.
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Summit Partners III, L.P.
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Stamps, Woodsum & Co.
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Summit Partners IV, L.P.
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Stamps, Woodsum & Co. II
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Summit Partners, LLC
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Stamps, Woodsum & Co. III
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Summit Partners Private Equity Fund VII-A, L.P.
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Stamps, Woodsum &Co. IV
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Summit Partners Private Equity Fund VII-B, L.P.
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Summit Accelerator Founders' Fund, L.P.
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Summit Partners S.a.r.l.
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Summit Accelerator Fund, L.P.
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Summit Partners SD II, LLC
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Summit Partners SD III, L.P.
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Summit Ventures V, L.P.
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Summit Partners SD III, LLC
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Summit Ventures VI-A, L.P.
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Summit Partners SD IV, LLC
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Summit Ventures VI-B HCP Blocker Corp.
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Summit Partners SD IV, LP
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Summit Ventures VI-B HCP, L.P.
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Summit Partners SD IV-A, LP
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Summit Ventures VI-B, L.P.
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Summit Partners SD IV-B, LP
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Summit Ventures, L.P.
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Summit Partners SD, L.P.
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Summit Verwaltings GmbH
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Summit Partners V S.a.r.l.
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Summit VI Advisors Fund, L.P.
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Summit Partners V, L.P.
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Summit VI Entrepreneurs Fund L.P.
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Summit Partners VC II LLC
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Summit/CAM Holdings, LLC
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Summit Partners VC II LP
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Summit/Meditech LLC
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Summit Partners Venture Capital Fund II-A, L.P.
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Summit/Sun Holdings, LLC
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Summit Partners Venture Capital Fund II-B, L.P.
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SV Eurofund, C.V.
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Summit Partners VI (GP), L.P.
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SV International, L.P.
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Summit Partners VI (GP), LLC
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SV VI -B Eyeglass Common Blocker Corp.
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Summit Partners VI-A France
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SV VI -B Eyeglass Preferred Blocker Corp.
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Summit Partners VI-A S.a.r.l.
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SV VI B Tippmann Common Blocker Corp.
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Summit Partners VI-B France
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SV VI B Tippmann Preferred Blocker Corp.
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Summit Partners VI-B S.a.r.l.
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SV VI Tippmann Holdings. L.P.
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Summit Partners VII-A S.a.r.l.
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SV VI-B Aurora Blocker Corp.
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Summit Partners VII-B S.a.r.l.
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SV VI-B Aurora Holdings, L.P.
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Summit Partners VIII S.a.r.l.
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SV VI-B Bennington Blocker Corp.
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Summit Partners, L.P.
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SV VI-B Bennington Holdings, L.P.
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Summit Partners, LP Profit Sharing Plan and Trust
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SV VI-B CAM Blocker Corp.
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Summit Partners, LP Savings and Investment Plan
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SV VI-B CAM Holdings, L.P.
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Summit Partners, Ltd.
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SV VI-B CD Blocker Corp.
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Summit Retained Earnings, L.P.
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SV VI-B CD Holdings, L.P.
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Summit Subordinated Debt Fund II, L.P.
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SV VI-B Commnet Common Blocker Corp.
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Summit Subordinated Debt Fund III-A, L.P.
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SV VI-B Commnet Holdings, L.P.
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Summit Subordinated Debt Fund III-B, L.P.
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SV VI-B Commnet Preferred Blocker Corp.
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Summit Subordinated Debt Fund, L.P.
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SV VI-B Eyeglass Holdings, L.P.
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Summit TRI, L.P.
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SV VI-B Focus Blocker Corp.
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Summit UK Advisory LLC
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SV VI-B Focus Holdings, L.P
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Summit V Advisors Fund QP, L.P.
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SV VI-B LiteCure Blocker Corp.
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Summit V Advisors Fund, L.P.
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SV VI-B LiteCure, L.P.
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Summit V Companion Fund, L.P.
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SV VI-B Tippmann Holdings. L.P.
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Summit Ventures II, L.P.
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SV VI-B Tivoli Blocker Corp.
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Summit Ventures III, L.P.
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SV VI-B Tivoli Holdings, LP
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Summit Ventures IV, L.P.
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SWC Holdings CO.
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