-----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, RS3GPlSdN3n+OkwE7A+tB8jvFzxJNH//75VyE77GpjtpuyrhHoD9/xidtHJXQfb6 nTskYbvBpAKtjnWOHLPjnw== 0000055772-96-000005.txt : 19960424 0000055772-96-000005.hdr.sgml : 19960424 ACCESSION NUMBER: 0000055772-96-000005 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960423 SROS: NASD GROUP MEMBERS: SERMERSHEIM A C FAMILY LTD PARTNERSHIP GROUP MEMBERS: SHIRLEY A. LEWIS, JANE M. HACKMAN, & RONALD J. SERMERSHEIM SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: KIMBALL INTERNATIONAL INC CENTRAL INDEX KEY: 0000055772 STANDARD INDUSTRIAL CLASSIFICATION: OFFICE FURNITURE [2520] IRS NUMBER: 350514506 STATE OF INCORPORATION: IN FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: SC 13D SEC ACT: 1934 Act SEC FILE NUMBER: 005-12986 FILM NUMBER: 96549466 BUSINESS ADDRESS: STREET 1: 1600 ROYAL ST CITY: JASPER STATE: IN ZIP: 47549 BUSINESS PHONE: 8124821600 MAIL ADDRESS: STREET 1: 1600 ROYAL STREET STREET 2: 1600 ROYAL STREET CITY: JASPER STATE: IN ZIP: 47549 FORMER COMPANY: FORMER CONFORMED NAME: JASPER CORP DATE OF NAME CHANGE: 19740826 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: SERMERSHEIM A C FAMILY LTD PARTNERSHIP CENTRAL INDEX KEY: 0001010778 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] IRS NUMBER: 351975964 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D BUSINESS ADDRESS: STREET 1: 1113 W 14TH ST CITY: JASPER STATE: IN ZIP: 47546 BUSINESS PHONE: 8124824939 MAIL ADDRESS: STREET 1: 1113 W 14TH ST CITY: JASPER STATE: IN ZIP: 47546 SC 13D 1 INITIAL SCHEDULE 13D CLASS A UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13D Under the Securities Exchange Act of 1934 (Amendment No. ______) Kimball International, Inc. _______________________________________________________________________________ (Name of Issuer) Class A Common Stock, $.31 1/4 Par Value _______________________________________________________________________________ (Title of Class of Securities) 494274 20 2 _______________________________________________________________________________ (CUSIP Number) A. C. Sermersheim Family Limited Partnership Ronald J. Sermersheim, General Partner 1113 W. 14th Street Jasper, IN 47546 (812) 482-4939 _______________________________________________________________________________ (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) February 21, 1996 _______________________________________________________________________________ (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-1(b)(3) or (4), check the following box [ ]. Check the following box if a fee is being paid with the statement [X]. (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 1; 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-1(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). No Exhibits SCHEDULE 13D CUSIP NO. 494274-20-2 ___________ _______________________________________________________________________________ 1 NAMES OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Shirley A. Lewis, General Partner A. C. Sermersheim Family Limited Partnership _______________________________________________________________________________ 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) /X/ (b) / / _______________________________________________________________________________ 3 SEC USE ONLY ______________________________________________________________________________ 4 SOURCE OF FUNDS OO _______________________________________________________________________________ 5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e) / / _______________________________________________________________________________ 6 CITIZENSHIP OR PLACE OF ORGANIZATION United States ________________________________________________________________________________ 7 SOLE VOTING POWER NUMBER OF 0 SHARES __________________________________________________________ BENEFICIALLY 8 SHARED VOTING POWER OWNED BY 405,500 EACH __________________________________________________________ REPORTING 9 SOLE DISPOSITIVE POWER PERSON 0 WITH __________________________________________________________ 10 SHARED DISPOSITIVE POWER 405,500 _______________________________________________________________________________ 11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 405,500 ________________________________________________________________________________ 12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES / / ________________________________________________________________________________ 13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 5.6% _______________________________________________________________________________ 14 TYPE OF REPORTING PERSON PN ______________________________________________________________________ * 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. SCHEDULE 13D CUSIP NO. 494274-20-2 ____________ _______________________________________________________________________________ 1 NAMES OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Jane M. Hackman, General Partner A. C. Sermersheim Family Limited Partnership _______________________________________________________________________________ 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) /X/ (b) / / _______________________________________________________________________________ 3 SEC USE ONLY _______________________________________________________________________________ 4 SOURCE OF FUNDS OO _______________________________________________________________________________ 5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e) / / _______________________________________________________________________________ 6 CITIZENSHIP OR PLACE OF ORGANIZATION United States ________________________________________________________________________________ 7 SOLE VOTING POWER NUMBER OF 105,400 SHARES __________________________________________________________ BENEFICIALLY 8 SHARED VOTING POWER OWNED BY 405,500 EACH __________________________________________________________ REPORTING 9 SOLE DISPOSITIVE POWER PERSON 105,400 WITH __________________________________________________________ 10 SHARED DISPOSITIVE POWER 405,500 _______________________________________________________________________________ 11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 510,900 ________________________________________________________________________________ 12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES / / ________________________________________________________________________________ 13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 7.0% ________________________________________________________________________________ 14 TYPE OF REPORTING PERSON PN ________________________________________________________________________________ * 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. SCHEDULE 13D CUSIP NO. 494274-20-2 ____________ _______________________________________________________________________________ 1 NAMES OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Ronald J. Sermersheim, General Partner A. C. Sermersheim Family Limited Partnership _______________________________________________________________________________ 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) /X/ (b) / / _______________________________________________________________________________ 3 SEC USE ONLY _______________________________________________________________________________ 4 SOURCE OF FUNDS OO _______________________________________________________________________________ 5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e) / / _______________________________________________________________________________ 6 CITIZENSHIP OR PLACE OF ORGANIZATION United States ________________________________________________________________________________ 7 SOLE VOTING POWER NUMBER OF 95,328 SHARES __________________________________________________________ BENEFICIALLY 8 SHARED VOTING POWER OWNED BY 405,500 EACH __________________________________________________________ REPORTING 9 SOLE DISPOSITIVE POWER PERSON 95,328 WITH __________________________________________________________ 10 SHARED DISPOSITIVE POWER 405,500 _______________________________________________________________________________ 11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 500,828 ________________________________________________________________________________ 12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES /X/ ________________________________________________________________________________ 13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 6.9% _______________________________________________________________________________ 14 TYPE OF REPORTING PERSON PN ______________________________________________________________________________ * 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. ITEM 1. SECURITY AND ISSUER This Statement on Schedule 13D relates to the Class A Common Stock, $.31 1/4 par value, of Kimball International, Inc., whose principal offices are located at 1600 Royal Street, Jasper, Indiana 47549. ITEM 2. IDENTITY AND BACKGROUND This Statement on Schedule 13D is filed with the Securities and Exchange Commission by Jane M. Hackman ("Hackman"), Shirley A. Lewis ("Lewis") and Ronald J. Sermersheim ("Sermersheim") as general partners of the A. C. Sermersheim Family Limited Partnership ("Limited Partnership"), an Indiana limited partnership. The Limited Partnership's principal address is 1113 West 14th Street, Jasper, IN 47546 Hackman's principal occupation is homemaker, Lewis's principal occupation is homemaker and Sermersheim's principal occupation is serving as the Vice President, Environment, Health & Safety, of Kimball International, Inc. During the past five years, Hackman, Lewis and Sermersheim have not been convicted in a criminal proceeding (excluding traffic violations or similar misdemeanors). During the past five years, Hackman, Lewis and Sermersheim have not been a party to a civil proceeding of a judicial or administrative body of competent jurisdiction where as a result of such proceeding Hackman, Lewis or Sermersheim was or is subject to a judgment, decree or final order enjoining future violations of, or prohibiting or mandating activities subject to, federal or state securities laws or finding any violation with respect to such laws. Hackman, Lewis and Sermersheim are citizens of the United States. ITEM 3. SOURCE AND AMOUNT OF FUNDS OR OTHER CONSIDERATION The Limited Partnership acquired the Common Stock through contributions of the stock made by each of the limited and general partners. ITEM 4. PURPOSE OF TRANSACTION The transfer of shares to the Limited Partnership was performed solely for estate planning and gift tax purposes and not for the purpose of attempting to control the company. ITEM 5. INTEREST IN SECURITIES OF THE ISSUER
(a) (a) (b) (b) (b) (b) Sole Shared Aggregate Sole Shared Power to Power to Amount Power Power Dispose Dispose Benefi- Percent to Vote to Vote or Direct or Direct cially of or Direct or Direct Disposi- Disposi- owned Class the Vote the Vote tion of tion of ________ _______ _________ _________ _________ _________ Hackman 510,900 7.0% 105,400 405,500 105,400 405,500 Lewis 405,500 5.6% 0 405,500 0 405,500 Sermersheim 500,828* 6.9% 95,328* 405,500 95,328* 405,500 * Does not include shares which may be deemed to be beneficially owned by the wife and minor children of Sermersheim.
(d) Not applicable. (e) Not applicable. ITEM 6. CONTRACTS, ARRANGEMENTS, UNDERSTANDINGS OR RELATIONSHIPS WITH RESPECT TO SECURITIES OF THE ISSUER Not applicable. 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. April 2, 1996 /s/ Jane M. Hackman ______________________________________________ Jane M. Hackman, General Partner A. C. Sermersheim Family Limited Partnership March 26, 1996 /s/ Shirley A. Lewis, General Partner _______________________________________________ Shirley A. Lewis, General Partner A. C. Sermersheim Family Limited Partnership March 15, 1996 /s/ Ronald J. Sermersheim _______________________________________________ Ronald J. Sermersheim, General Partner A. C. Sermersheim Family Limited Partnership Attention: Intentional misstatements or omissions of fact constitute Federal Criminal Violations (See 18 U.S.C. 1001). -----END PRIVACY-ENHANCED MESSAGE-----