-----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, J4YhPMr8lp3Mton9wRITk1KwatZXptA5+7Gr+kFAddiPmSnDSMTRoDyJJm8vOgyA wL+kxxsy8EaVvNF3Hq/Cdg== 0000891020-02-000103.txt : 20020414 0000891020-02-000103.hdr.sgml : 20020414 ACCESSION NUMBER: 0000891020-02-000103 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20020212 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BSQUARE CORP /WA CENTRAL INDEX KEY: 0001054721 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 911650880 STATE OF INCORPORATION: WA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-58461 FILM NUMBER: 02536710 BUSINESS ADDRESS: STREET 1: 3150 139TH AVE SE SUITE 500 CITY: BELLEVUE STATE: WA ZIP: 98005 BUSINESS PHONE: 4255195900 MAIL ADDRESS: STREET 1: 3150 139TH AVE SE SUITE 500 CITY: BELLEVUE STATE: WA ZIP: 98005 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: DOSSER ALBERT T CENTRAL INDEX KEY: 0001137045 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: C/O BSQUARE CORP STREET 2: 3150 139TH AVENUE SE STE 500 CITY: BELLEVUE STATE: WA ZIP: 98005 BUSINESS PHONE: 4255195963 MAIL ADDRESS: STREET 1: C/O BSQUARE CORP STREET 2: 3150 139TH AVENUE SE STE 500 SC 13G/A 1 v79053asc13ga.txt SCHEDULE 13 G/A FOR AL DOSSER SCHEDULE 13G (RULE 13d-102) Information to be Included in Statements Filed Pursuant to Rule 13d-1(b), (c) and (d) and Amendments Thereto Filed Pursuant to Rule 13d-2. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 Under the Securities Exchange Act of 1934 (Amendment No. 1)* BSQUARE CORP. ----------------------------------------- (Name of Issuer) Common Stock ----------------------------------------- (Title of Class of Securities) 11776U102 ----------------------------------------- (CUSIP Number) May 4, 2001 (first sale of 2001) --------------------------------------------------------- (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) [ ] Rule 13d-1(c) [X] Rule 13d-1(d) *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. 11776U102 SCHEDULE 13G PAGE OF PAGES --------------------- ----- ----- 1 Names of Reporting Persons/I.R.S. Identification Nos. of Above Persons (Entities Only) Albert T. Dosser --------------------------------------------------------------------- 2 Check the Appropriate Box if a Member of a Group (a) [ ] (See Instructions) (b) [ ] --------------------------------------------------------------------- 3 SEC Use Only --------------------------------------------------------------------- 4 Citizenship or Place of Organization United States --------------------------------------------------------------------- 5 Sole Voting Power Number of 4,350,000 (as of Dec. 31, 2001) Shares -------------------------------------------------------- Beneficially 6 Shared Voting Power Owned by Each -------------------------------------------------------- Reporting 7 Sole Dispositive Power Person With 4,350,000 -------------------------------------------------------- 8 Shared Dispositive Power -------------------------------------------------------- 9 Aggregate Amount Beneficially Owned by Each Reporting Person 4,350,000 --------------------------------------------------------------------- 10 Check box if the Aggregate Amount in Row (9) Excludes Certain Shares [ ] (See Instructions) --------------------------------------------------------------------- 11 Percent of Class Represented by Amount in Row (9) 12.5% (assumes total of 34,875,585) --------------------------------------------------------------------- 12 Type of Reporting Person (See Instructions) IN --------------------------------------------------------------------- Answer every item. If an item is inapplicable or the answer is in the negative, so state. ITEM 1(a) Name of Issuer: Bsquare Corp. ITEM 1(b) Address of Issuer's Principal Executive Offices: 3150 139th Ave. SE Suite 500 Bellevue, WA 98005 ITEM 2(a) Name of Person Filing: Albert T. Dosser ITEM 2(b) Address of Principal Business Office or, if None, Residence: 16340 NE 83rd St. Redmond, WA 98052 ITEM 2(c) Citizenship: United States ITEM 2(d) Title of Class of Securities: Common Stock ITEM 2(e) CUSIP Number: 11776U102 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: ITEM 4. OWNERSHIP. Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1. (a) Amount Beneficially Owned: 4,350,000 (b) Percent of Class: 12.5% (c) Number of shares as to which such person has: (i) Sole power to vote or to direct the vote: 4,350,000 (ii) Shared power to vote or to direct the vote: -- (iii) Sole power to dispose or to direct the disposition of: 4,350,000 (iv) Shared power to dispose or to direct the disposition of: -- 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 [ ]. Instruction. Dissolution of a group requires a response to this item. ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON. ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY OR CONTROL PERSON. ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP. ITEM 9. NOTICE OF DISSOLUTION OF GROUP. ITEM 10. CERTIFICATIONS. SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement if true, complete and correct. February 7, 2002 ----------------------------------------- (Date) /s/ ALBERT T. DOSSER ----------------------------------------- (Signature) ALBERT T. DOSSER ----------------------------------------- (Name and Title) The original statement shall be signed by each person on whose behalf the statement is filed or his authorized representative. If the statement is signed on behalf of a person by his authorized representative (other than an executive officer or general partner of the filing person), evidence of the representative's authority to sign on behalf of such person shall be filed with the statement, provided, however, that a power of attorney for this purpose which is already on file with the Commission may be incorporated by reference. The name and any title of each person who signs the statement shall be typed or printed beneath this signature. Note: Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits. See Rule 13d-7 for other parties for whom copies are to be sent. ATTENTION: INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACT CONSTITUTE FEDERAL CRIMINAL VIOLATIONS (SEE 18 U.S.C. 1001) -----END PRIVACY-ENHANCED MESSAGE-----