SEC FORM
4
SEC Form 4
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
CROSS COUNTRY HEALTHCARE INC
[ CCRN ]
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5. 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) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 04/14/2005
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock, par value $0.0001 per share
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04/14/2005 |
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S |
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3,955,264 |
D |
$16.6
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0 |
I
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through partnerships |
Common Stock, par value $0.0001 per share
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04/14/2005 |
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S |
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217,604 |
D |
$16.6
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217,605 |
I
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through partnerships |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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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 |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
1221 AVENUE OF THE AMERICAS |
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(Street)
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1. Name and Address of Reporting Person*
1221 AVENUE OF THE AMERICAS |
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(Street)
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1. Name and Address of Reporting Person*
1221 AVENUE OF THE AMERICAS |
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(Street)
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1. Name and Address of Reporting Person*
1221 AVENUE OF THE AMERICAS |
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(Street)
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1. Name and Address of Reporting Person*
1221 AVENUE OF THE AMERICAS |
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(Street)
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1. Name and Address of Reporting Person*
1221 AVENUE OF THE AMERICAS |
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(Street)
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1. Name and Address of Reporting Person*
1221 AVENUE OF THE AMERICAS |
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(Street)
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1. Name and Address of Reporting Person*
1221 AVENUE OF THE AMERICAS |
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(Street)
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Explanation of Responses: |
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/s/ Peter Vogelsang, authorized signatory for Morgan Stanley |
04/15/2005 |
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/s/ Kenneth F. Clifford, CFO of Metalmark Subadvisor LLC, as attorney-in-fact of the general partner of the MSDW IV Funds, for each of these entities |
04/15/2005 |
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/s/ Debra Abramovitz, Executive Director of MSVC III, Inc., institutional managing member of the general partner of the MSDW III Funds, for each of these entities |
04/15/2005 |
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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
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). |
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. |
EXHIBIT 99.1
Joint Filer Information
Each of the following joint filers has designated Morgan Stanley as the Designated Filer for the purposes of the attached Form 4:
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(1) |
Morgan Stanley Venture Capital III, Inc. (MSVC III, Inc.)
1221 Avenue of the Americas
New York, New York 10020 |
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(2) |
Morgan Stanley Venture Partners III, L.L.C. (MSVP III, L.L.C.)
1221 Avenue of the Americas
New York, New York 10020 |
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(3) |
Morgan Stanley Venture Partners III, L.P. (MSVP III, L.P.)
1221 Avenue of the Americas
New York, New York 10020 |
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(4) |
Morgan Stanley Venture Partners Entrepreneur Fund, L.P. (the Entrepreneur Fund)
1221 Avenue of the Americas
New York, New York
10020 |
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(5) |
Morgan Stanley Venture Investors III, L.P. (MSVI III, L.P.)
1221 Avenue of the Americas
New York, New York 10020 |
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(6) |
MSDW Capital Partners IV, Inc. (MSDWCP IV, Inc.)
1221 Avenue of the Americas
New York, New York 10020 |
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(7) |
MSDW Capital Partners IV, LLC (MSDWCP IV, LLC)
1221 Avenue of the Americas
New York, New York 10020 |
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(8) |
Morgan Stanley Dean Witter Capital Partners IV, L.P. (MSDWCP IV, L.P.)
1221 Avenue of the Americas
New York, New York 10020 |
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(9) |
MSDW IV 892 Investors, L.P. (MSDW IV 892, L.P.)
1221 Avenue of the Americas
New York, New York 10020 |
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(10) |
Morgan Stanley Dean Witter Capital Investors IV, L.P. (MSDWCI IV, L.P.)
1221 Avenue of the Americas
New York, New York 10020 |
Issuer & Ticker Symbol: Cross Country, Inc. (CCRN)
Date of Event Requiring Statement: 04/14/05
Signature:
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/s/ Peter Vogelsang
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By: Peter Vogelsang, as authorized signatory for
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Morgan Stanley
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Signature:
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/s/ Kenneth F. Clifford
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By: Kenneth F. Clifford, Chief Financial Officer
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of Metalmark Subadvisor LLC, as attorney-in-fact
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of MSDWCP IV, LLC, the general partner of
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MSDWCP IV, L.P., MSDW IV 892, L.P. and
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MSDWCPI IV, L.P.
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Signature: |
/s/ Debra Abramovitz
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By: Debra Abramovitz, Executive Director of
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MSVC III, Inc., institutional managing member of
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MSVP III, L.L.C., the general partner of MSVP
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III, L.P., the Entrepreneur Fund and MSVI III,
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L.P.
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