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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 01/08/2016 | 3. Issuer Name and Ticker or Trading Symbol COMPUTER PROGRAMS & SYSTEMS INC [ CPSI ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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) |
Common Stock | 1,938,968 | I | See Footnotes(1)(3) |
Common Stock | 26,637 | I | See Footnotes(2)(3) |
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 |
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. Directly owned by Francisco Partners II, L.P. ("FPII"). |
2. Directly owned by Francisco Partners Parallel Fund II, L.P. ("FPPII"). |
3. Francisco Partners GP II, L.P. ("FPGPII") is the sole general partner of FPII and FPPII. Francisco Partners GP II Management, LLC ("FPMII," and together with FPII, FPPII, and FPGPII, "Francisco Partners") is the sole general partner of FPGPII. |
Remarks: |
See Exhibit 99.1 Joint Filer Information. |
Francisco Partners II, L.P., By: Francisco Partners GP II, L.P., its General Partner, By: Francisco Partners GP II Management, LLC, its General Partner, By: /s/ Tom Ludwig, Name: Tom Ludwig, Title: Managing Member | 02/17/2016 | |
Francisco Partners Parallel Fund II, L.P., By: Francisco Partners GP II, L.P., its General Partner, By: Francisco Partners GP II Management, LLC, its General Partner, By: /s/ Tom Ludwig, Name: Tom Ludwig, Title: Managing Member | 02/17/2016 | |
Francisco Partners GP II, L.P., By: Francisco Partners GP II Management, LLC, its General Partner, By: /s/ Tom Ludwig, Name: Tom Ludwig, Title: Managing Member | 02/17/2016 | |
Francisco Partners GP II Management, LLC, By: /s/ Tom Ludwig, Name: Tom Ludwig, Title: Managing Member | 02/17/2016 | |
** 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. |