-----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, L1k8zq1QO/zzmEg5PvOSVydV/4n4O4q/sWL1phnim1OrrpIGJiMhtxvfK6t1BxW3 MCWr6bP0KUIvu0+5LPLKFw== 0000950152-02-001074.txt : 20020414 0000950152-02-001074.hdr.sgml : 20020414 ACCESSION NUMBER: 0000950152-02-001074 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20020214 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: 0403 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-32158 FILM NUMBER: 02543029 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 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 l92729asc13ga.txt SHOPSMITH, INC./JOHN FOLKERTH SC 13G/A SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1(b)(c), AND (d) AND AMENDMENTS THERETO FILED PURSUANT TO RULE 13d-2(b) (Amendment No. 21)* SHOPSMITH, INC. ------------------------------------------------------- (Name of Issuer) COMMON SHARES - NO PAR VALUE ------------------------------------------- (Title of Class of Securities) 825098 10 6 ------------------------------------------------------- (CUSIP Number) NOT APPLICABLE ---------------- (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 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 - -------------------------------------------------------------------------------- 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 358,545 -------------------------------------- BENEFICIALLY 6 SHARED VOTING POWER OWNED BY 228,507 -------------------------------------- 7 SOLE DISPOSITIVE POWER EACH 358,545 -------------------------------------- REPORTING 8 SHARED DISPOSITIVE POWER PERSON 228,507 -------------------------------------- WITH 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 587,052 - -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 22.5% - -------------------------------------------------------------------------------- 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) OR (c) STATEMENT. - ------ ------------------------------------------- Not applicable. ITEM 4. OWNERSHIP. - ------ --------- The following information concerning ownership of Common Shares is given as of December 31, 2001: CUSIP No. 825098 10 6 Page 4 of 5 Pages (a) Amount Beneficially Owned: 320,212 shares directly owned 20,000 shares covered by options exercisable within 60 days 228,507 shares owned indirectly (by spouse) 18,333 shares owned indirectly (401(k) Plan) ------- 587,052 Total (b) Percent of Class: 22.5% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote: 358,545 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: 358,545 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 OR CONTROL PERSON. -------------------------- 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 12, 2002 /s/ John R. Folkerth ---------------------------------------------- JOHN R. FOLKERTH -----END PRIVACY-ENHANCED MESSAGE-----