CUSIP NO. 714290103 13G/A PAGE 1 OF 7 PAGES
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SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G/A
Information to be included in Statements filed pursuant to
Rules 13d-1(b), (c), and (d) and Amendments
thereto filed pursuant to Rule 13d-2(b)
(Amendment No. 4)(1)
PERRIGO COMPANY
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(Name of Issuer)
Common Stock, without par value
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(Title of Class of Securities)
714290103
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(CUSIP Number)
November 14, 2004
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(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule
is filed:
[ ] Rule 13d-1(b)
[X] Rule 13d-1(c)
[ ] Rule 13d-1(d)
(1) The remainder of this cover page shall be filled out for a reporting
person's initial filing on this form with respect to the subject class of
securities, and for any subsequent amendment containing information which
would alter the disclosures provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed
to be "filed" for the purpose of Section 18 of the Securities Exchange Act of
1934 ("Act") or otherwise subject to the liabilities of that section of the Act
but shall be subject to all other provisions of the Act (however, see the
Notes).
Page 1 of 7 Pages
No Exhibit Index
CUSIP NO. 714290103 13G/A PAGE 2 OF 7 PAGES
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1. Names of Reporting Persons.
I.R.S. Identification Nos. of above persons (entities only).
Michael J. Jandernoa
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2. Check the Appropriate Box if a Member of a Group (See Instructions)
(a) [ ]
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(b) [ ]
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3. SEC Use Only
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4. Citizenship or Place of Organization
United States
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Number of 5. Sole Voting Power
Shares 6,084,055
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Beneficially 6. Shared Voting Power
Owned by 0
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Each 7. Sole Dispositive Power
Reporting 6,084,055
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Person With: 8. Shared Dispositive Power
0
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9. Aggregate Amount Beneficially Owned by Each Reporting Person
6,560,245
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10. Check if the Aggregate Amount in Row (9) Excludes Certain Shares
(See Instructions)
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11. Percent of Class Represented by Amount in Row (9)
9.2%
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12. Type of Reporting Person (See Instructions)
IN
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* SEE INSTRUCTION BEFORE FILLING OUT!
** SEE ITEM 4 OF THIS FILING
CUSIP NO. 714290103 13G/A PAGE 3 OF 7 PAGES
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1. Names of Reporting Persons.
I.R.S. Identification Nos. of above persons (entities only).
Michael J. Jandernoa Trust
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2. Check the Appropriate Box if a Member of a Group (See Instructions)
(a) [ ]
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(b) [ ]
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3. SEC Use Only
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4. Citizenship or Place of Organization
Michigan
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Number of 5. Sole Voting Power
Shares 5,926,597
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Beneficially 6. Shared Voting Power
Owned by 0
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Each 7. Sole Dispositive Power
Reporting 5,926,597
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Person With: 8. Shared Dispositive Power
0
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9. Aggregate Amount Beneficially Owned by Each Reporting Person
5,926,597
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10. Check if the Aggregate Amount in Row (9) Excludes Certain Shares
(See Instructions)
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11. Percent of Class Represented by Amount in Row (9)
8.3%
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12. Type of Reporting Person (See Instructions)
OO--Trust
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* SEE INSTRUCTION BEFORE FILLING OUT!
** SEE ITEM 4 OF THIS FILING
CUSIP NO. 714290103 13G/A PAGE 4 OF 7 PAGES
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ITEM 1.
(a) Name of Issuer: Perrigo Company
(b) Address of Issuer's Principal Executive Offices: 515 Eastern Avenue
Allegan, Michigan 49010
ITEM 2.
(a) - (c) Name, Principal Business Address and Citizenship of Person Filing:
Michael J. Jandernoa
c/o Law Weathers & Richardson
333 Bridge Street, NW, Suite 800
Grand Rapids, Michigan 49504
Citizenship: United States
(d) Title of Class of Securities: Common Stock, without par value.
(e) CUSIP Number: 714290103
ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D-1(B), OR
13D-2(B) OR (C), CHECK WHETHER THE PERSON FILING IS A:
(a) - (j) Not Applicable.
ITEM 4. OWNERSHIP
(a) Mr. Jandernoa is the beneficial owner of 6,560,245 shares of the
Issuer's common stock, without par value. Mr. Jandernoa owns 2,191
shares of the Issuer's common stock. The Michael J. Jandernoa Trust, of
which Mr. Jandernoa is the sole trustee, holds 5,926,597 shares of the
Issuer's common stock. The Michael J. Jandernoa Grantor Trust 2, of
which Mr. Jandernoa is the sole trustee and has a reversionary
interest, holds 136,986 shares of the Issuer's common stock. Mr.
Jandernoa holds sole voting and dispositive power in both the Michael
J. Jandernoa Trust and the Michael J. Jandernoa Grantor Trust 2. The
Susan M. Jandernoa Trust holds 339,204 shares of the Issuer's common
stock. Mrs. Jandernoa is the sole trustee and holds sole voting and
dispositive power for the shares of common stock held by the Susan M.
Jandernoa Trust. The Susan M. Jandernoa Grantor Trust 2 holds 136,986
shares of the Issuer's common stock. Mrs. Jandernoa is the sole trustee
and holds sole voting and dispositive power for the shares of common
stock held by the Susan M. Jandernoa Grantor Trust 2. Mr. Jandernoa
holds stock options that give him the right to acquire 18,281 shares of
the Issuer's common stock within 60 days of the date of this filing.
The figures above are as of October 31, 2004.
CUSIP NO. 714290103 13G/A PAGE 5 OF 7 PAGES
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On November 14, 2004, Mr. Jandernoa entered into a Voting Agreement
with Agis Industries (1983) Ltd., an Israeli public company ("Agis")
pursuant to which Mr. Jandernoa agreed to vote all shares of Issuer's
common stock owned by him on the date of the vote in favor of the
issuance of Issuer common stock contemplated in the merger of one of
Issuer's subsidiaries with and into Agis (the "Share Issuance"). In
addition, pursuant to the Voting Agreement, Mr. Jandernoa has executed
and delivered to Agis an irrevocable proxy to vote all shares owned by
him in favor of the Share Issuance. As a result of the Voting Agreement
and the related proxy, Mr. Jandernoa has no voting power with respect
to the Share Issuance, but he retains voting power with respect to all
other matters. The Voting Agreement does not affect Mr. Jandernoa's
dispositive power.
(b) As of October 31, 2004, Mr. Jandernoa was the beneficial owner of 9.2%
of the Issuer's outstanding common stock, without par value. The
Issuer's most recent Form 10-Q (for the quarterly period ended
September 25, 2004) lists 71,217,193 shares of the Issuer's common
stock, outstanding as of October 13, 2004. In addition, Mr. Jandernoa
holds stock options, which give him the right to acquire 18,281 shares
of the Issuer's common stock within 60 days of the date of this filing.
Mr. Jandernoa's beneficial ownership percentage is based on a total of
71,235,474 shares of the Issuer's common stock, which consists of the
Issuer's outstanding common stock plus shares that would become
outstanding if Mr. Jandernoa exercised his stock options.
As of October 31, 2004, the Michael J. Jandernoa Trust held 8.3% of the
Issuer's outstanding common stock, without par value. The beneficial
ownership percentage of the Michael J. Jandernoa Trust is based on the
Issuer's 71,217,193 shares of common stock outstanding as of September
25, 2004.
(c) (i) Mr. Jandernoa has sole power to vote or direct the vote of
6,084,055 shares of common stock.
(ii) Mr. Jandernoa does not share power to vote or to direct the
vote of any shares of common stock.
(iii) Mr. Jandernoa has sole power to dispose or direct the
disposition of 6,084,055 shares of common stock.
(iv) Mr. Jandernoa does not share power to dispose or to direct the
disposition of any shares of common stock.
ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS
Not Applicable.
ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON
The Michael J. Jandernoa Trust, of which Mr. Jandernoa is the trustee,
holds 5,926,597 shares of the Issuer's common stock.
CUSIP NO. 714290103 13G/A PAGE 6 OF 7 PAGES
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ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH
ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING
COMPANY
Not Applicable.
ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP
Not Applicable.
ITEM 9. NOTICE OF DISSOLUTION OF GROUP
Not Applicable.
ITEM 10. CERTIFICATION
By signing below I certify that, to the best of my knowledge and
belief, the securities referred to above were not acquired and are not held for
the purpose of or with the effect of changing or influencing the control of the
issuer of the securities and were not acquired and are not held in connection
with or as a participant in any transaction having that purpose or effect.
CUSIP NO. 714290103 13G/A PAGE 7 OF 7 PAGES
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SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
November 23, 2004
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Date
/s/ Michael J. Jandernoa
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Signature
/s/ Michael J. Jandernoa
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As trustee of the Michael J. Jandernoa
Trust and in his individual capacity