-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, RUoAHNP//S2pM7NCGF1l7q1/pJpIrkzbxhqGfNluHCSr9V4RO3dqD+SrdCA8ANkY uMmrJD3aaU1SqZeTH81h4g== /in/edgar/work/20000705/0001019687-00-000917/0001019687-00-000917.txt : 20000920 0001019687-00-000917.hdr.sgml : 20000920 ACCESSION NUMBER: 0001019687-00-000917 CONFORMED SUBMISSION TYPE: SC 13D/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20000705 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CVI TECHNOLOGY INC CENTRAL INDEX KEY: 0001004673 STANDARD INDUSTRIAL CLASSIFICATION: [5099 ] IRS NUMBER: 911696010 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D/A SEC ACT: SEC FILE NUMBER: 005-56183 FILM NUMBER: 667539 BUSINESS ADDRESS: STREET 1: 6830 SPENCER STREET CITY: LAS VEGAS STATE: NV ZIP: 89119 BUSINESS PHONE: 7027337195 MAIL ADDRESS: STREET 1: 6830 SPENCER STREET CITY: LAS VEGAS STATE: NV ZIP: 89119 FORMER COMPANY: FORMER CONFORMED NAME: CASINOVATIONS INC DATE OF NAME CHANGE: 19970710 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: SMITH BOB L CENTRAL INDEX KEY: 0001084600 STANDARD INDUSTRIAL CLASSIFICATION: [ ] FILING VALUES: FORM TYPE: SC 13D/A BUSINESS ADDRESS: STREET 1: 6744 S SPENCER STREET CITY: LAS VEGAS STATE: NV ZIP: 89119 BUSINESS PHONE: 7027337195 MAIL ADDRESS: STREET 1: 6744 S SPENCER STREET CITY: LAS VEGAS STATE: NV ZIP: 89119 SC 13D/A 1 0001.txt BOB SMITH AMENDMENT NO. 4 ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0145 Expires: November 30, 1999 Estimated average burden hours per response ..... 14.90 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13D UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. 4)* CVI TECHNOLOGY, INC. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock $.001 par value - -------------------------------------------------------------------------------- (Title of Class of Securities) 12660V 10 7 - -------------------------------------------------------------------------------- (CUSIP Number) Stacie L. Brown, 6830 Spencer Street, Las Vegas, Nevada 89119; Tel.: (702) 733-7195 - -------------------------------------------------------------------------------- (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) May 31, 2000 - -------------------------------------------------------------------------------- (Date of Event which Requires Filing of this Statement) If the filing person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because of Rule 13d-l(b)(3) or (4), check the following box [ ] Check the following box if a fee is being paid with the statement [ ]. (A fee is not required only if the reporting person: (1) has a previous statement on file reporting beneficial ownership of more than five percent of the class of securities described in Item l; and (2) has filed no amendment subsequent thereto reporting beneficial ownership of five percent or less of such class.) (See Rule 13d-7.) NOTE: Six copies of this statement, including all exhibits, should be filed with the Commission. See Rule 13d-l(a) for other parties to whom copies are to be sent. *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 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). 1 CUSIP No. 12660V10 7 13D Page 2 of 4 Pages ________________________________________________________________________________ 1. Name of Reporting Persons. I.R.S. Identification Nos. of above person Bob L. Smith ________________________________________________________________________________ 2. Check the Appropriate Box If a Member of a Group (See Instructions) (a) [_] (b) [_] ________________________________________________________________________________ 3. SEC Use Only ________________________________________________________________________________ 4. Source of Funds (See Instructions) Not applicable. ________________________________________________________________________________ 5. Check If Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e) [_] Not applicable. ________________________________________________________________________________ 6. Citizenship or Place of Organization United States ________________________________________________________________________________ 7. Sole Voting Power NUMBER OF 420,395 shares SHARES _________________________________________________________________ BENEFICIALLY 8. Shared Voting Power OWNED BY 346,816 shares EACH _________________________________________________________________ REPORTING 9. Sole Dispositive Power PERSON 420,395 shares WITH _________________________________________________________________ 10. Shared Dispositive Power 346,816 shares ________________________________________________________________________________ 11. Aggregate Amount Beneficially Owned by Each Reporting Person 767,211 ________________________________________________________________________________ 12. Check Box If the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions) [_] ________________________________________________________________________________ 13. Percent of Class Represented by Amount in Row (11) 7.06% ________________________________________________________________________________ 14. Type of Reporting Person (See Instructions) IN ________________________________________________________________________________ *SEE INSTRUCTIONS BEFORE FILLING OUT! INCLUDE BOTH SIDES OF THE COVER PAGE, RESPONSES TO ITEMS 1-7 (INCLUDING EXHIBITS) OF THE SCHEDULE, AND THE SIGNATURE ATTESTATION. This Amendment No. 4 amends the Schedule 13D dated April 23, 1999 (the "Schedule 13D"), the Amendment No. 1 dated September 22, 1999, (the "First Amendment"), the Amendment No. 2 dated March 22, 2000, (the "Second Amendment"), and the Amendment No. 3 dated May 31, 2000, (the "Third Amendment") of Bob L. Smith with respect to the common stock, $.001 par value ("Common Stock") of CVI Technology, Inc., a Nevada corporation (the "Issuer"). Except as specifically provided herein, this Amendment No. 4 does not modify any of the information previously reported on the Schedule 13D or the First, Second or Third Amendments. Item 3. Source of Funds or Other Considerations Not applicable. Item 4. Purpose of Transaction The filing of this Amendment No. 4 to Schedule 13D is to include, in number of shares reported, the 50,000 shares represented by the Warrant Issuer issued to VIP's Industries, Inc. in connection with the May 31, 2000, transaction reported in Mr. Smith's Third Amendment. Item 5. Interest in Securities of the Issuer Bob L. Smith Presently Owned Percentage(4) ------------ --------------- ------------- Sole Voting Power 420,395(1,2) 3.9% Shared Voting Power 346,816(3) 3.19% Sole Dispositive Power 420,395(1,2) 3.9% Shared Dispositive Power 346,816(3) 3.19% Total Beneficial Power 767,211 7.06% - ----------------- (1) This amount represents 344,195 shares of Common Stock issued directly to Mr. Smith, 18,200 shares of Common Stock issuable to Mr. Smith upon the exercise of certain warrants, 55,000 shares of Common Stock issuable to Mr. Smith upon the exercise of certain stock options, and 3,000 shares of Common Stock issuable to Mr. Smith upon the exercise of certain stock options. (2) Shares of Common Stock may be subject to applicable community property laws. (3) This amount represents 176,236 shares of Common Stock held by VIP's Industries, Inc., an entity controlled by Mr. Smith, 1,000 shares of Common Stock issued jointly to Mr. Smith and his daughter, 33,557 shares of Common Stock issuable to VIP's Industries, Inc. upon the exercise of Class A Warrants, 9,100 shares of Common Stock issuable to VIP's Industries, Inc. upon the exercise of certain warrants, 76,923 shares of Common Stock issuable to VIP's Industries, Inc. upon the conversion of that certain 9.5% Convertible Note Due May 31, 2001, and 50,000 shares of Common Stock issuable to VIP's Industries, Inc. upon the exercise of certain warrants. (4) These percentages reflect the percentage share ownership with respect to 10,854,799 shares, the number of shares of Common Stock outstanding as of May 31, 2000. 3 Item 7. Material to be Filed as Exhibits Not Applicable. 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. Dated: July 5, 2000 /s/ Stacie L. Brown ------------------- Stacie L. Brown, Attorney-In-Fact for Bob L. Smith 4 -----END PRIVACY-ENHANCED MESSAGE-----