-----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, JV6FogfukWB5hYqqZd5uemFUIVl2qwJdQTm7uyzpNgFzuC/fIp/jLFC/NQmxsqJ2 Y9/XKluiW3Km1ryNPOYAmg== 0001007349-96-000003.txt : 19960216 0001007349-96-000003.hdr.sgml : 19960216 ACCESSION NUMBER: 0001007349-96-000003 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960215 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 SEC ACT: 1934 Act SEC FILE NUMBER: 005-32158 FILM NUMBER: 96520602 BUSINESS ADDRESS: STREET 1: 6530 POE AVENUE CITY: DAYTON STATE: OH ZIP: 45414 BUSINESS PHONE: 5138986070 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: FOLKERTH ROBERT L CENTRAL INDEX KEY: 0001007349 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 66 E DIXON AVE CITY: DAYTON STATE: OH ZIP: 45419 BUSINESS PHONE: 5134355710 MAIL ADDRESS: STREET 1: 66 E DIXON AVE CITY: DAYTON STATE: OH ZIP: 45419 SC 13G 1 SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. __)* Shopsmith, Inc. ________________ (Name of Issuer) Common Shares, No Par Value ______________________________ (Title of Class of Securities) 825098 10 6 ______________ (CUSIP Number) Check the following box if a fee is being paid with this statement X. (A fee is not required only if the filing 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). *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 Robert L. 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 136,097 6 SHARED VOTING POWER -0- 7 SOLE DISPOSITIVE POWER 136,097 8 SHARED DISPOSITIVE POWER -0- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 136,097 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 5.1% 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: Robert L. Folkerth (b) Address of Principal Business Office: 8641 Washington Church Road Miamisburg, Ohio 45342 (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. _______ __________ The following information concerning ownership of Common Shares is given as of December 31, 1995: CUSIP No. 825098 10 6 Page 4 of 5 Pages (a) Amount Beneficially Owned: 123,050 shares directly owned 13,047 shares owned indirectly (by trust and children) _______ 136,097 Total (b) Percent of Class: 5.1% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote: 136,097 Common Shares (ii) shared power to vote or to direct the vote: -0- Common Shares (iii) sole power to dispose or to direct the disposition of: 136,097 Common Shares (iv) shared power to dispose or to direct the disposition of: -0- 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 8, 1996 /s/Robert Folkerth ROBERT L. FOLKERTH PCN2618.HIG -----END PRIVACY-ENHANCED MESSAGE-----