-----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, R7//9XyJofI+M7+2DYv4IkeA221o4TKuqqHWxLMUTkPz0qSK3HTE5l+Bx5+HoS6i 70lVaU2bADVINMZOD/0VYA== 0000950124-97-000506.txt : 19970211 0000950124-97-000506.hdr.sgml : 19970211 ACCESSION NUMBER: 0000950124-97-000506 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970207 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN DENTAL TECHNOLOGIES INC CENTRAL INDEX KEY: 0000874388 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 382905258 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-42033 FILM NUMBER: 97520070 BUSINESS ADDRESS: STREET 1: 28411 NORTHWESTERN HWY STREET 2: STE 1100 CITY: SOUTHFIELD STATE: MI ZIP: 48034 BUSINESS PHONE: 3136490000 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: NICHOLS CHARLES A CENTRAL INDEX KEY: 0001018976 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 5555 BEAR LANE CITY: CORPUS CHRISTI STATE: TX ZIP: 784045 BUSINESS PHONE: 5122891145 MAIL ADDRESS: STREET 1: 5555 BEAR LANE CITY: CHORPUS CHRISTI STATE: TX ZIP: 78405 SC 13G 1 SC 13G 1 SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. ) ----------- AMERICAN DENTAL TECHNOLOGIES, INC. ---------------------------------- (Name of Issuer) $.01 PAR VALUE COMMON STOCK ------------------------------ (Title of Class of Securities) 025352-10-5 ----------- (CUSIP Number) Charles A. Nichols *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. Page 1 of 3 pages 2 1) Names of Reporting Persons S.S. or I.R.S. Identification Nos. of Above Persons: Charles A. Nichols / ###-##-#### 2) Check the Appropriate Box if a Member of a Group (See Instructions): N/A (a) (b) 3) SEC Use Only: 4) Citizenship or Place of Organization: United States Number of shares 5) Sole Voting Power: 1,990,850 Beneficially Owned 6) Shared Voting Power N/A by Each Reporting 7) Sole Dispositive Power 1,990,850 Person With: 8) Shared Dispositive Power N/A 9) Aggregate Amount Beneficially Owned by Each Reporting Person: 1,990,850 10) Check if the Aggregate Amount in Row (9) Excludes Certain Shares: N/A 11) Percent of Class Represented by Amount in Row 9: 7.2% 12) Type of Reporting Person IN
Page 2 of 3 Pages 3 ITEM 1(a) NAME OF ISSUER: American Dental Technologies, Inc. ITEM 1(b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: 28411 Northwestern Highway Ste. 1100, Southfield, MI 48034 ITEM 2(a) NAME OF PERSON FILING: Charles A. Nichols ITEM 2(b) ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, 5555 Bear Lane IF NONE, RESIDENCE: Corpus Christi, TX 78405 ITEM 2(c) CITIZENSHIP: United States ITEM 2(d) TITLE OF CLASS OF SECURITIES: $0.01 par value Common Stock ITEM 2(e) CUSIP NUMBER: 025352 10 5 ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 13d-1(b), OR 13d-2(b), CHECK WHETHER THE PERSON FILING IS A: N/A ITEM 4. OWNERSHIP: The following information is as of December 31, 1996. (a) Amount Beneficially Owned: 1,990,850 (b) Percent of Class: 7.2% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote: 1,990,850 (ii) shared power to vote or to direct the vote: None (iii) sole power to dispose or to direct the disposition of: 1,990,850 (iv) shared power to dispose or to direct the disposition of: None The information above excludes a warrant held by Mr. Nichols to purchase 1,203,863 shares of common stock at a purchase price of $1.4104 per share for a period commencing August 1, 1997 and ending July 31, 1999. ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS N/A ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON N/A ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY N/A ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP N/A ITEM 9. NOTICE OF DISSOLUTION OF GROUP N/A ITEM 10. CERTIFICATION N/A
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. Date: February 7, 1997 /s/ Charles A. Nichols ----------------------- Charles A. Nichols Attention: Intentional misstatements or omissions of fact constitute criminal violations (See 18 USC 1001) Page 3 of 3 Pages -----END PRIVACY-ENHANCED MESSAGE-----