SEC 1745 |
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UNITED STATES |
SECURITIES AND EXCHANGE COMMISSION |
Washington, D.C. 20549 |
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SCHEDULE 13G |
Under
the Securities Exchange Act of 1934
(Amendment No. )*
Waters Instruments, Inc.
(Name of Issuer)
Common Stock
(Title of Class of Securities)
941850109
(CUSIP Number)
July 29, 2003
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
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Rule 13d-1(b) |
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Rule 13d-1(c) |
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Rule 13d-1(d) |
*The remainder of this cover page shall be filled out for a reporting persons 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. 941850109 |
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1. |
Names of Reporting Persons. I.R.S.
Identification Nos. of above persons (entities only) |
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2. |
Check the Appropriate Box if a Member of a Group (See Instructions) |
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(a) |
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(b) |
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3. |
SEC Use Only |
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4. |
Citizenship or Place of
Organization |
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Number of |
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Sole Voting Power |
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6. |
Shared Voting Power
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7. |
Sole Dispositive Power
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8. |
Shared Dispositive Power |
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9. |
Aggregate Amount Beneficially Owned
by Each Reporting Person |
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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) |
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12. |
Type of Reporting Person (See
Instructions) |
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Item 1. |
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(a) |
Name of Issuer |
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(b) |
Address of Issuers Principal
Executive Offices |
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Item 2. |
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(a) |
Name of Person Filing |
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(b) |
Address of Principal Business
Office or, if none, Residence |
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(c) |
Citizenship |
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(d) |
Title of Class of Securities |
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(e) |
CUSIP Number |
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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: |
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(a) |
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Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o). |
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(b) |
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Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c). |
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(c) |
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Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c). |
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(d) |
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Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C 80a-8). |
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(e) |
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An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E); |
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(f) |
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An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F); |
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(g) |
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A parent holding company or control person in accordance with § 240.13d-1(b)(1)(ii)(G); |
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(h) |
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A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813); |
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(i) |
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A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3); |
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(j) |
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Group, in accordance with §240.13d-1(b)(1)(ii)(J). |
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Item 4. |
Ownership |
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Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1. |
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As of December 31, 2004, the beneficial ownership of shares of the Reporting Person was as follows: |
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(a) |
Amount beneficially owned: 255,929 |
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(b) |
Percent of class: 8.932% |
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(c) |
Number of shares as to which the person has: |
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(i) |
Sole power to vote or to direct the vote 24,061 |
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(ii) |
Shared power to vote or to direct the vote 231,868 |
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(iii) |
Sole power to dispose or to direct the disposition of 24,061 |
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(iv) |
Shared power to dispose or to direct the disposition of 231,868 |
Of the shares listed above as beneficially owned, 216,979 shares are indirectly owned by Mr. Schiefelbein as personal representative of the Estate of Charles Schiefelbein, and 105,000 shares are indirectly owned as trustee of the Peace Shalom Foundation. Mr. Schiefelbein disclaims beneficial ownership of any of these shares. |
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Item 5. |
Ownership of Five Percent or Less of a Class |
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Not Applicable |
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Item 6. |
Ownership of More than Five Percent on Behalf of Another Person |
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See Item 4 above. |
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Item 7. |
Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company or Control Person |
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Not Applicable |
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Item 8. |
Identification and Classification of Members of the Group |
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Not Applicable |
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Item 9. |
Notice of Dissolution of Group |
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Not Applicable |
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Item 10. |
Certification |
(a) Not Applicable |
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(b) 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 securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect. |
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.
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December 31, 2004 |
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Date |
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Signature |
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Name/Title |
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