-----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, QYomKv7VGqWRkHnICXMA2WM12ikW9VGMnzIZhvKOR8MrBerAPniQUqRlWI3WBWno MmczNAOGmPEUUYNXLBbrMg== 0000089925-97-000003.txt : 19970222 0000089925-97-000003.hdr.sgml : 19970222 ACCESSION NUMBER: 0000089925-97-000003 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970213 SROS: NONE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SHOPSMITH INC CENTRAL INDEX KEY: 0000089925 STANDARD INDUSTRIAL CLASSIFICATION: SPECIAL INDUSTRY MACHINERY (NO METALWORKING MACHINERY) [3550] IRS NUMBER: 310811466 STATE OF INCORPORATION: OH FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-32158 FILM NUMBER: 97528859 BUSINESS ADDRESS: STREET 1: 6530 POE AVENUE CITY: DAYTON STATE: OH ZIP: 45414 BUSINESS PHONE: 5138986070 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: FOLKERTH JOHN R CENTRAL INDEX KEY: 0000901784 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 131 FORRER BLVD CITY: DAYTON STATE: OH ZIP: 45414 BUSINESS PHONE: 5134634936 MAIL ADDRESS: STREET 1: 131 FORRER BLVD CITY: DAYTON STATE: OH ZIP: 45419 SC 13G/A 1 SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. 16)* Shopsmith, Inc. (Name of Issuer) Common Shares, No Par Value (Title of Class of Securities) 825098 10 6 (CUSIP Number) *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). (Continued on following page(s)) Page 1 of 5 Pages CUSIP NO. 825098 10 6 13G Page 2 of 5 Pages 1 NAME OF REPORTING PERSON John R. Folkerth S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON S.S. # ###-##-#### 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 SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH 5 SOLE VOTING POWER 336,267.4 6 SHARED VOTING POWER 228,507 7 SOLE DISPOSITIVE POWER 336,267.4 8 SHARED DISPOSITIVE POWER 228,507 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 564,774.4 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 20.8% 12 TYPE OF REPORTING PERSON* IN *SEE INSTRUCTION BEFORE FILLING OUT! CUSIP No. 825098 10 6 Page 3 of 5 Pages Item 1. (a) Name of Issuer: Shopsmith, Inc. (b) Address of Issuer's Principal Executive Offices: 6530 Poe Avenue Dayton, Ohio 45414 Item 2. (a) Name of Person Filing: John R. Folkerth (b) Address of Principal Business Office: 6530 Poe Avenue Dayton, Ohio 45414 (c) Citizenship: United States of America (d) Title of Class of Securities: Common Shares, without par value (e) CUSIP Number: 825098 10 6 Item 3. Rules 13d-1(b) or 13d-2(b) Statement. Not applicable. Item 4. Ownership. Except as otherwise indicated, the following information concerning ownership of Common Shares is given as of December 31, 1996: CUSIP No. 825098 10 6 Page 4 of 5 Pages (a) Amount Beneficially Owned: 268,712.0 shares directly owned 54,166.0 shares covered by options exercisable within 60 days 228,507.0 shares owned indirectly (by spouse) 13,389.4 shares owned indirectly (401(k) Plan - as of 9/30/96) 564,774.4 Total (b) Percent of Class: 20.8% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote: 336,267.4 Common Shares (ii) shared power to vote or to direct the vote: 228,507 Common Shares (iii) sole power to dispose or to direct the disposition of: 336,267.4 Common Shares (iv) shared power to dispose or to direct the disposition of: 228,507 Common Shares Item 5. Ownership of Five Percent or Less of a Class. Not applicable. 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. CUSIP No. 825098 10 6 Page 5 of 5 Pages 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. Date: February 11, 1997 /s/ John R. Folkerth JOHN R. FOLKERTH SHOPSMITH/PMR1351.KSR -----END PRIVACY-ENHANCED MESSAGE-----