-----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, SBCdnCLHxRG75XNFun1AAIMB+QaAub5LrfJL/hDeiayoa25PfA90D89TdwnrWIek Nm3/Z+RVj+VnhpUkfIxeXg== 0000914190-00-000030.txt : 20000203 0000914190-00-000030.hdr.sgml : 20000203 ACCESSION NUMBER: 0000914190-00-000030 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20000131 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: HEALTH FITNESS CORP /MN/ CENTRAL INDEX KEY: 0000886432 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 411580506 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: SEC FILE NUMBER: 005-46567 FILM NUMBER: 517884 BUSINESS ADDRESS: STREET 1: 3500 W 80TH ST STREET 2: STE 130 CITY: BLOOMINGTON STATE: MN ZIP: 55431 BUSINESS PHONE: 6128316830 MAIL ADDRESS: STREET 2: 3500 WEST 80TH STREET CITY: BLOOMINGTON STATE: MN ZIP: 55431 FORMER COMPANY: FORMER CONFORMED NAME: HEALTH FITNESS PHYSICAL THERAPY INC DATE OF NAME CHANGE: 19940916 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: BRINK LOREN S CENTRAL INDEX KEY: 0001008558 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 3500 WEST 80TH STREET STREET 2: SUITE 130 CITY: BLOOMINGTON STATE: MN ZIP: 55431 SC 13G/A 1 SCHEDULE 13G AMENDMENT 4 SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. 4)* Health Fitness Corporation (Name of Issuer) Common Stock, $.01 par value (Title of Class of Securities) 42217V 10 2 (CUSIP Number) (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 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). Page 1 of 4 Pages SCHEDULE 13G CUSIP No. 42217V 10 2 Page 2 of 4 Pages 1 NAMES OF REPORTING PERSONS/ I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY) Loren S. Brink 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [ ] 3 SEC USE ONLY 4 CITIZENSHIP OR PLACE OF ORGANIZATION U.S.A. NUMBER OF 5 SOLE VOTING POWER SHARES 920,378 (includes 200,000 shares which may be purchased upon BENEFICIALLY exercise of options which are exercisable at 12/31/99 or OWNED BY within 60 days) EACH REPORTING PERSON WITH 6 SHARED VOTING POWER 0 7 SOLE DISPOSITIVE POWER 920,378 (includes 200,000 shares which may be purchased upon exercise of options which are exercisable at 12/31/99 or within 60 days) 8 SHARED DISPOSITIVE POWER 0 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 920,378 (includes 200,000 shares which may be purchased upon exercise of options which are exercisable at 12/31/99 or within 60 days) 10 CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 7.5% 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: Health Fitness Corporation Item 1(b) Address of Issuer's Principal Executive Offices: 3500 W. 80th Street Minneapolis, MN 55401 Item 2(a) Name of Person Filing: See Cover Page Item 1 Item 2(b) Address of Principal Business Office or, if none, residence: 3500 W. 80th Street Minneapolis, MN 55401 Item 2(c) Citizenship: See Cover Page Item 4 Item 2(d) Title of Class of Securities: Common Stock, $.01 par value Item 2(e) CUSIP No.: See Cover Page Item 3 Statement filed pursuant to Rule 13d-1(b), or 13d-2(b) or (c): Not applicable Item 4 Ownership See Cover Page Items 5 through 11 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 [ ]. Item 6 Ownership of More than Five Percent on Behalf of Another Person: Not applicable 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: 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. February 28, 2000 (Date) /s/ Loren S. Brink (Signature) Loren S. Brink (Name and title) -----END PRIVACY-ENHANCED MESSAGE-----