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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
TA SUBORDINATED DEBT FUND LP 125 HIGH STREET SUITE 2500 BOSTON, MA 02110 |
See General Remarks |
TA Subordinated Debt Fund L.P. | 03/15/2005 | |
**Signature of Reporting Person | Date | |
By: TA Associates SDF LLC, its General Partner | 03/15/2005 | |
**Signature of Reporting Person | Date | |
By: TA Associates, Inc., its Manager | 03/15/2005 | |
**Signature of Reporting Person | Date | |
By: Thomas P. Alber, Chief Financial Officer | 03/15/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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) | TA Subordinated Debt Fund L.P., a member of a group that owns more that 10% of Tempur-Pedic International, Inc., in the aggregate, distributed 400,000 shares pro rata for no consideration to the partners of TA Subordinated Debt Fund L.P. |
(2) | Not Applicable |
Remarks: Member of a filing group which owns more than 10% in the aggregate. |