-----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, MdjPvigeqoPfdZ/YVLLl0I9aTEJR3IsSAbap51A/gRn2VQpkLmLs6slYBcSyLl+c tZhyp3JtmuIdcDAi3wWD4g== 0001012394-97-000004.txt : 19970222 0001012394-97-000004.hdr.sgml : 19970222 ACCESSION NUMBER: 0001012394-97-000004 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970214 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: EP MEDSYSTEMS INC CENTRAL INDEX KEY: 0001012394 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 223212190 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-48865 FILM NUMBER: 97534507 BUSINESS ADDRESS: STREET 1: 58 ROUTE 46 WEST CITY: BUDD LAKE STATE: NJ ZIP: 07828 BUSINESS PHONE: 2016916400 MAIL ADDRESS: STREET 1: 58 ROUTE 46 WEST CITY: BUDD LAKE STATE: NJ ZIP: 07828 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: EP MEDSYSTEMS INC CENTRAL INDEX KEY: 0001012394 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 223212190 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 58 ROUTE 46 WEST CITY: BUDD LAKE STATE: NJ ZIP: 07828 BUSINESS PHONE: 2016916400 MAIL ADDRESS: STREET 1: 58 ROUTE 46 WEST CITY: BUDD LAKE STATE: NJ ZIP: 07828 SC 13G 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. ________ )* EP MedSystems, Inc. -------------------------------- (Name of Issuer) Common Stock ------------------------------------ (Title of Class of Securities) 26881-P-103 ------------------------------------ (CUSIP Number) Check the following box if a fee is being paid with this statement X . (A fee is not required only if the filing person: (1) has a previous statement on file reporting beneficial ownership of more than five percent of the class of securities described in Item 1; and (2) has filed no amendment subsequent thereto reporting beneficial ownership of five percent or less of such class.) (See Rule 13d-7). * 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 in 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). CUSIP No.26881-P-103 13G Page 2 of 4 Pages 1 NAME OF REPORTING PERSON David A. Jenkins S.S. OR I.R.S. ID NO. OF ABOVE PERSON ###-##-#### 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A (a) GROUP (b) 3 SEC USE ONLY 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States Citizen NUMBER OF 5 SOLE VOTING POWER 255,000 shares SHARES BENEFICIALLY 6 SHARED VOTING POWER 640,000 shares OWNED BY 7 SOLE DISPOSITIVE POWER 255,000 shares EACH REPORTING 8 SHARED DISPOSITIVE POWER 640,000 shares PERSON WITH 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 895,000 shares 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN 11.6% ROW 9 12 TYPE OF REPORTING PERSON IN CUSIP No. 26881-P-103 13G Page 2 of 4 Pages GENERAL INSTRUCTIONS A.Statements containing the information required by this schedule shall be filed not later than February 14 following the calendar year covered by the statement or within the time specified in Rule 13d- 1(b)(2), if applicable. B.Information contained in a form which is required to be filed by rules under section 13(f) (15 U.S.C. 78m(f)) for the same calendar year as that covered by a statement on this schedule may be incorporated by reference in response to any of the items of this schedule. If such information is incorporated by reference in this schedule, copies of the relevant pages of such form shall be filed as an exhibit to this schedule. C.The item numbers and captions of the items shall be included but the text of the items is to be omitted. The answers to the items shall be so prepared as to indicate clearly the coverage of the items without referring to the text of the items. Answer every item. If an item is inapplicable or the answer is in the negative, so state. ITEM 1. (a) Name of Issuer EP MedSystems, Inc. (b) Address of Issuer's Principal Executive Offices 58 Route 46 West Budd Lake, NJ 07828 ITEM 2. (a) Name of Person Filing David A. Jenkins (b) Address of Principal Business Office or Residence 58 Route 46 West Budd Lake, NJ 07828 (c) Citizenship United States Citizen (d) Title of Class of Securities Common Stock (e) CUSIP Number 26881-P-103 ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D- 1(B), OR 13D-2(B), CHECK WHETHER THE PERSON FILING IS A: Not Applicable ITEM 4. OWNERSHIP If the percent of the class owned, as of December 31 of the year covered by the statement, or as of the last day of any month described in Rule 13d-1(b)(2), if applicable, exceeds five percent, provide the following information as of that date and identify those shares which there is a right to acquire. (a) Amount Beneficially Owned 895,000 shares (b) Percent of Class 11.6% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote 255,000 shares (ii) shares power to vote or to direct the vote 640,000 shares (iii)sole power to dispose or to direct the disposition of 255,000 shares (iv) shared power to dispose or to direct the disposition 640,000 shares Instruction: For computations regarding securities which represent a right to acquire an underlying security see Rule 13d-3(d)(1). ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following . Not applicable Instruction: Dissolution of a group requires a response to this item. ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON Not applicable 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 The following certification shall be included if the statement if filed pursuant to Rule 13d-1(b): By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were acquired in the ordinary course of business and were not acquired for the purpose of and do not have the effect of changing or influencing the control of the issuer of such securities and were not acquired in connection with or as a participant in any transaction having such purposes or effect. 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. February 13, 1997 ------------------- Date /s/ David A. Jenkins --------------------- Signature David A. Jenkins --------------------- Name -----END PRIVACY-ENHANCED MESSAGE-----