-----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, KQ/AzJElM5ikBbQcgkMS19I7Ls7S+y4Zx/TkmMvSVLyHLLrVssiymzo31rFBs1eF U6bm5JyJtljmiB59rqw/NQ== 0000950159-04-000343.txt : 20040329 0000950159-04-000343.hdr.sgml : 20040329 20040329165359 ACCESSION NUMBER: 0000950159-04-000343 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040329 GROUP MEMBERS: ERIC D. JACOBS SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CENTRAL BANCORP INC /MA/ CENTRAL INDEX KEY: 0001076394 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 043447594 STATE OF INCORPORATION: MA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-55695 FILM NUMBER: 04696841 BUSINESS ADDRESS: STREET 1: 399 HIGHLAND AVENUE CITY: SOMERVILLE STATE: MA ZIP: 02144 BUSINESS PHONE: 6176284000 MAIL ADDRESS: STREET 1: 399 HIGHLAND AVENUE CITY: SOMERVILLE STATE: MA ZIP: 02144 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: MILLER JEFFREY A CENTRAL INDEX KEY: 0001032442 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: P O BOX 26039 STREET 2: GALLOWS BAY STATION CITY: CHRISTIANSTED STATE: VI ZIP: 00824 BUSINESS PHONE: 3407731300 MAIL ADDRESS: STREET 1: P O BOX 26039 STREET 2: GALLOWS BAY STATION CITY: CHRISTIANSTED STATE: VI ZIP: 00824 SC 13G 1 centralbc13g.txt SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 ------------------------- SCHEDULE 13G (Rule 13d-102) INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1(b), (c) AND (d) AND AMENDMENTS THERETO FILED PURSUANT TO 13d-2(b) (Amendment No. 1)1 Central Bancorp, Inc. (Name of Issuer) Common Stock, $1.00 par value per share ------------------------------------------------------------------------------- (Title of Class of Securities) 152418109 - -------------------------------------------------------------------------------- (CUSIP NUMBER) March 17, 2004 (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 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 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). - -------------------------------------------------------------------------------- NAME OF REPORTING PERSONS: Jeffrey A. Miller 1. I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) - -------------------------------------------------------------------------------- CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* 2. (a) [ ] (b) |X| - -------------------------------------------------------------------------------- SEC USE ONLY 3. - -------------------------------------------------------------------------------- CITIZENSHIP OR PLACE OF ORGANIZATION United States of America 4. - -------------------------------------------------------------------------------- 5. NUMBER OF SOLE VOTING POWER 0 SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH - -------------------------------------------------------------------------------- SHARED VOTING POWER 0 6. - -------------------------------------------------------------------------------- SOLE DISPOSITIVE POWER 0 7. - -------------------------------------------------------------------------------- SHARED DISPOSITIVE POWER 0 8. - -------------------------------------------------------------------------------- 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 0 - -------------------------------------------------------------------------------- CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES 10. CERTAIN SHARES* - -------------------------------------------------------------------------------- PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 0% 11. - -------------------------------------------------------------------------------- TYPE OF REPORTING PERSON* IN 12. - -------------------------------------------------------------------------------- *SEE INSTRUCTION BEFORE FILLING OUT! -2- - -------------------------------------------------------------------------------- NAME OF REPORTING PERSONS: Eric D. Jacobs 1. I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) - -------------------------------------------------------------------------------- CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* 2. (a) [ ] (b) |X| - -------------------------------------------------------------------------------- SEC USE ONLY 3. - -------------------------------------------------------------------------------- CITIZENSHIP OR PLACE OF ORGANIZATION United States of America 4. - -------------------------------------------------------------------------------- 5. NUMBER OF SOLE VOTING POWER 0 SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH - -------------------------------------------------------------------------------- SHARED VOTING POWER 0 6. - -------------------------------------------------------------------------------- SOLE DISPOSITIVE POWER 0 7. - -------------------------------------------------------------------------------- SHARED DISPOSITIVE POWER 0 8. - -------------------------------------------------------------------------------- AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 0 9. - -------------------------------------------------------------------------------- CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES 10. CERTAIN SHARES* - -------------------------------------------------------------------------------- PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 0% 11. - -------------------------------------------------------------------------------- TYPE OF REPORTING PERSON* IN 12. - -------------------------------------------------------------------------------- *SEE INSTRUCTION BEFORE FILLING OUT! -3- Item 1(a). Name of Issuer: Central Bancorp, Inc. Item 1(b). Address of Issuer's Principal Executive Offices: 399 Highland Avenue Somerville, MA 02144 Item 2(a). Name of Persons Filing: Jeffrey A. Miller Eric D. Jacobs (together, the "Reporting Persons") Item 2(b). Address of Principal Business Office or, if None, Residence: The principal business address of the Reporting Persons is: P.O. Box 26039 Gallows Bay Station Christiansted, St. Croix, USVI 00824 Item 2(c). Citizenship: Jeffrey A. Miller: United States of America Eric D. Jacobs: United States of America Item 2(d). Title of Class of Securities: Common Stock, $1.00 par value per share Item 2(e). CUSIP Number: 152418109 -4- 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: Not Applicable (a) [ ] Broker or dealer registered under Section 15 of the Exchange Act; (b) [ ] Bank as defined in Section 3(a)(6) of the Exchange Act; (c) [ ] Insurance Company as defined in Section 3(a)(19) of the Exchange Act; (d) [ ] Investment Company registered under Section 8 of the Investment Company Exchange Act; (e) [ ] Investment Adviser in accordance with Rule 13d-1(b)(1)(ii)(E); (f) [ ] Employee Benefit Plan or Endowment Fund in accordance with Rule 13d-1(b)(1)(ii)(F); (g) [ ] Parent Holding Company or Control Person in accordance with Rule 13d-1(b)(1)(ii)(G); (h) [ ] Saving Association as defined in Section 3(b) of The Federal Deposit Insurance Act; (i) [ ] Church Plan that is excluded from the definition of an Investment Company under Section 3(c)(14) of the Investment Company Act; (j) [ ] Group, in accordance with Rule 13d-1(b)(1)(ii)(J). Item 4. Ownership. A. Jeffrey A. Miller (a) Amount beneficially owned: 0 (b) Percent of Class: 0% (c) Number of shares as to which such person has: (i) Sole power to vote or direct the vote: 0 (ii) Shared power to vote or to direct the vote: 0 (iii)Sole power to dispose or direct the disposition of: 0 (iv) Shared power to dispose or to direct the disposition of: 0 B. Eric D. Jacobs (a) Amount beneficially owned: 0 (b) Percent of Class: 0% -5- (c) Number of shares as to which such person has: (i) Sole power to vote or direct the vote: 0 (ii) Shared power to vote or to direct the vote: 0 (iii)Sole power to dispose or direct the disposition of: 0 (iv) Shared power to dispose or to direct the disposition of: 0 As calculated in accordance with Rule 13d-3 of the Securities Exchange Act of 1934, as amended, Jeffrey A. Miller and Eric D. Jacobs no longer own, directly or indirectly, any shares of the Issuer's Common Stock, $1.00 par value per share ("Common Stock"). 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: [X] 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. 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. -6- 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: March 29, 2004 /s/ Jeffrey A. Miller ------------------------ Jeffrey A. Miller /s/ Eric D. Jacobs ------------------------ Eric D. Jacobs EXHIBIT INDEX Exhibits - -------- 1. Joint Filing Agreement, dated March 29, 2004, by and between Jeffrey A. Miller and Eric D. Jacobs. -7- EXHIBIT 1 --------- JOINT FILING AGREEMENT The undersigned hereby agree that this Statement on Schedule 13G with respect to the beneficial ownership of shares of Common Stock, par value $1.00 per share, of Central Bancorp, Inc. is filed jointly, on behalf of each of them. Dated: March 29, 2004 /s/ Jeffrey A. Miller ------------------------- Jeffrey A. Miller /s/ Eric D. Jacobs ------------------------- Eric D. Jacobs -----END PRIVACY-ENHANCED MESSAGE-----