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OMB APPROVAL
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OMB Number: 3235-0104
Expires: December 31, 2001
Estimated average burden
hours per response........0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL 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(f) of the Investment Company Act of 1940
(Print of Type Responses)
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1. Name and Address of Reporting Person*
HWP Nightingale II, LLC
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(Last) (First) (Middle)
c/o Haas Wheat & Partners, L.P.
300 Crescent Court, Suite 1700
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(Street)
Dallas TX 75201
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
11/12/2001
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
AMN Healthcare Services, Inc. ("AHS")
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [X] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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6. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form Filed by One Reporting Person
[_] Form Filed by More than One Reporting Person
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TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 4)
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Common Stock, par value $.01 per share 3,395,621 I (1)
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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).
POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTION OF INFORMATION CONTAINED
IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY
VALID OMB NUMBER.
(Over)
SEC 1473(3-99)
FORM 3 (continued)
TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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Explanation of Responses:
(1) The Reporting Person is the general partner of HWP Nightingale II, L.P.,
which is the general partner of HWP Nightingale Partners II, L.P., and may be
deemed to beneficially own the securities held by HWP Nightingale Partners II,
L.P. The Reporting Person disclaims beneficial ownership of such securities in
excess of its direct or indirect interest in the profits or capital accounts of
HWP Nightingale II, L.P. or HWP Nightingale Partners II, L.P. and this report
shall not be deemed an admission that the Reporting Person is the beneficial
owner of these securities in excess of such amount.
The Reporting Person may be deemed a member of a Section 13(d) group that owns
more than 10% of the Issuer's outstanding Common Stock. However, the Reporting
Person disclaims such group membership, and this report shall not be deemed an
admission that the Reporting Person is a member of a Section 13(d) group that
owns more than 10% of the Issuer's outstanding Common Stock for purposes of
Section 16 or for any other purpose.
By: /s/ Robert Haas November 13, 2001
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**Signature of Reporting Person Date
Name: Robert Haas
Title: Managing Member
** 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 provided is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB Number.
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