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 | ||||
Stock Option (Right to Buy Class A Common Stock) | 08/01/2017 | 11/15/2026 | Class A Common Stock, par value $0.01 per share | 321,736 (2) | $ 28.63 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Bell Michael Adam C/O INC RESEARCH HOLDINGS, INC. 3201 BEECHLEAF COURT, SUITE 600 RALEIGH, NC 27604 |
 X |  |  Exec Chair & Pres, Comm Div |  |
/s/ Christopher L. Gaenzle, Attorney-in-Fact | 08/03/2017 | |
**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) | Reflects Class A Common Stock, par value $0.01 ("Common Stock"), of INC Research Holdings, Inc. (the "Issuer") received at the effective time of the merger (the "Merger") of Double Eagle Parent, Inc. ("Double Eagle") with and into the Issuer pursuant to the Agreement and Plan of Merger, dated as of May 10, 2017 (the "Merger Agreement"), by and between Double Eagle and the Issuer, in connection with the Reporting Person's ownership prior to the Merger of common stock of Double Eagle and restricted stock units of Double Eagle (which were converted to Common Stock pursuant to the terms of the Merger Agreement). |
(2) | Represents options to purchase Common Shares, which were converted from options held by the reporting person immediately preceding the Merger and previously exercisable on a one-to-one basis for shares of Double Eagle common stock, based upon a conversion formula tied to the Per Share Consideration pursuant to the Merger Agreement. |