UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Mandatorily Convertible Cumulative Part Pref Stock, Series B | Â (3) | Â (4) | Non-Voting Common Stock | 274,283.86 | $ 1 | I (1) | By Stadium Capital Partners, L.P. |
Mandatorily Convertible Cumulative Part Pref Stock, Series B | Â (3) | Â (4) | Non-Voting Common Stock | 23,850.76 | $ 1 | I (2) | By Stadium Capital Qualified Partners, L.P. |
Warrant | 01/23/2012 | 01/23/2015 | Non-Voting Common Stock | 782,000 | $ 1 | I (1) | By Stadium Capital Partners, L.P. |
Warrant | 01/23/2012 | 01/23/2015 | Non-Voting Common Stock | 68,000 | $ 1 | I (2) | By Stadium Capital Qualified Partners, L.P. |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
STADIUM CAPITAL MANAGEMENT LLC 199 ELM STREET NEW CANAAN, CT 06840-5321 |
 X |  X |  |  |
KENT BRADLEY R 199 ELM STREET NEW CANAAN, CT 06840 |
 |  X |  |  |
STADIUM CAPITAL PARTNERS L P 199 ELM STREET NEW CANAAN, CT 06840 |
 X |  |  |  |
STADIUM CAPITAL QUALIFIED PARTNERS LP 199 ELM STREET NEW CANAAN, CT 06840 |
 X |  |  |  |
SEAVER ALEXANDER M 199 ELM STREET NEW CANAAN, NY 06840 |
 |  X |  |  |
Stadium Capital Management, LLC, by Bradley R. Kent, Manager | 02/02/2012 | |
**Signature of Reporting Person | Date | |
Alexander M. Seaver | 02/02/2012 | |
**Signature of Reporting Person | Date | |
Bradley R. Kent | 02/02/2012 | |
**Signature of Reporting Person | Date | |
Stadium Capital Partners, L.P., by Stadium Capital Management, LLC, its general partner, by Bradley R. Kent, Manager | 02/02/2012 | |
**Signature of Reporting Person | Date | |
Stadium Capital Qualified Partners, L.P., by Stadium Capital Management, LLC, its general partner, by Bradley R. Kent, Manager | 02/02/2012 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The reported securities are owned directly by Stadium Capital Partners, L.P., and indirectly by Stadium Capital Management, LLC as general partner of Stadium Capital Partners, L.P., Alexander M. Seaver as a manager of Stadium Capital Management, LLC, and Bradley R. Kent as a manager of Stadium Capital Management, LLC. Stadium Capital Management, LLC, Alexander M. Seaver and Bradley R. Kent disclaim beneficial ownership of the reported securities except to the extent of their respective pecuniary interests therein. |
(2) | The reported securities are owned directly by Stadium Capital Qualified Partners, L.P., and indirectly by Stadium Capital Management, LLC as general partner of Stadium Capital Qualified Partners, L.P., Alexander M. Seaver as a manager of Stadium Capital Management, LLC, and Bradley R. Kent as a manager of Stadium Capital Management, LLC. Stadium Capital Management, LLC, Alexander M. Seaver and Bradley R. Kent disclaim beneficial ownership of the reported securities except to the extent of their respective pecuniary interests therein. |
(3) | The Preferred Stock, Series B, will automatically convert into a new series of non-voting common stock at a conversion price of $1.00 per share upon approval by Intermountain's shareholders of an amendment to Intermountain's Articles of Incorporation to authorize shares of non-voting stock. |
(4) | Expiration date is not applicable. |
 Remarks: Stadium Capital Partners, L.P. and Stadium Capital Qualified Partners, L.P. are jointly entitled to appoint a representative to Intermountain's board of directors pursuant to their respective securities purchase agreements as reported by Intermountain in a Form 8-K filed with the SEC on 1/23/12.  John L. Welborn Jr. was appointed to the board of Intermountain pursuant to these contractual rights. |