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 | ||||
LP Exchangeable Units (3) | 12/20/2005 | Â (4) | Class A Common Stock | 56,087 | $ (5) | I | See Footnote. (6) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
LEBLANC ROBERT M C/O ONEX INVESTMENT CORPORATION 712 FIFTH AVENUE NEW YORK, NY 10019 |
 X |  |  |  |
/s/ Robert M. Le Blanc, Director of Emergency Medical Service | 12/15/2005 | |
**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) | Each share of class B common stock, par value $0.01, of the issuer (the "Class B Common Stock") is exchangeable at any time, at the option of the holder, for one share of class A common stock of the issuer. |
(2) | Represents shares indirectly owned by Mr. Le Blanc and includes shares beneficially owned by EMSC, Inc., notwithstanding the fact that Mr. Le Blanc has a pecuniary interest in less than 100% of such shares. Mr. Le Blanc disclaims beneficial ownership of these securities, and the inclusion of such shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. |
(3) | The LP Exchangeable Units represent equity interests in Emergency Medical Services L.P. Each LP Exchangeable Unit is exchangeable at any time, at the option of the holder, for one share of Class B Common Stock. Each share of Class B Common Stock is convertible at any time, at the option of the holder, for one share of class A common stock of the issuer. |
(4) | No Expiration. |
(5) | Exchangeable on a one-for-one basis. |
(6) | Represents shares indirectly owned by Mr. Le Blanc and includes shares beneficially owned by Onex US Principals LP and Onex EMSC Co-Invest LP. The inclusion of such shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. |
 Remarks: NOTE: The information in this Form 3 gives effect to the formation of Emergency Medical Services Corporation as a holding company and an anticipated 1.5-for-1 stock split, as described under "Formation of Holding Company" in the company's Registration Statement on Form S-1 (No. 333-127115). |