SEC FORM
3
SEC Form 3
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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
C/O BAIN CAPITAL, LLC |
111 HUNTINGTON AVENUE |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/02/2004
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3. Issuer Name and Ticker or Trading Symbol
CMGI INC
[ CMGI ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
X |
Other (specify below) |
See Footnote (4) |
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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)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Common Stock, $0.01 par value |
20,170,492 |
I |
See Footnotes
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of Responses: |
Remarks: |
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/s/ Michael F. Goss, Bain Capital Investors, LLC |
08/03/2004 |
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** 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. |
rrd40875_46377.html
Attachment to Form 3
Pursuant to Instruction 5(b)(v) of the General Instructions to Form 3, this
Form 3 is also being filed on behalf of the Reporting Persons set forth below.
All of the information set forth in the attached Form 3 for Bain Capital
Investors, LLC is the same for the Reporting Persons set forth below unless
otherwise noted.
TABLE I: Non-Derivative Securities
Ownership
Form of
Derivative Nature of
Amount Security: Indirect
or Number Direct (D) or Beneficial
Name and Address of Reporting Person of Shares Indirect (I) Ownership
- ------------------------------------- ------------ -------------- --------------
Bain Capital Fund IV, L.P. 11,059,221 D
Information Partners 389,331 D
BCIP Associates 641,116 D
BCIP Trust Associates, L.P. 380,700 D
Bain Capital Partners V, L.P. 7,694,938 D
BCIP Trust Associates II 3,942 D
BCIP Trust Associates II-B 1,244 D
Bain Capital Partners IV, L.P. 11,448,552 I (2)
Signature of Reporting Persons:
BAIN CAPITAL INVESTORS, LLC for itself, on behalf of itself
in its capacity as general partner of Bain Capital Partners
IV, L.P., on behalf of Bain Capital Partners IV, L.P. in its
capacity as general partner of Bain Capital Fund IV, L.P.
and in its capacity as managing partner of Information
Partners, for itself in its capacity as general partner of
Bain Capital Partners V, L.P., for itself in its capacity as
sole member of the management committee of BCIP Associates
and BCIP Trust Associates, L.P. and for itself in its
capacity as managing partner of BCIP Trust Associates II and
BCIP Trust Associates II-B.
By: /s/ Michael F. Goss
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Name: Michael F. Goss
Title: Managing Director