-----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, QE9hQhMD1Q489Dzi24uDNDBJ6loEX/euIbfqkiYaDT3mnZaigqroDHL1DEcyc5bJ epxsj0TZZJ6X1QPMEfM+7A== 0001010313-96-000001.txt : 19960315 0001010313-96-000001.hdr.sgml : 19960315 ACCESSION NUMBER: 0001010313-96-000001 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960314 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 13D SEC ACT: 1934 Act SEC FILE NUMBER: 005-32158 FILM NUMBER: 96534588 BUSINESS ADDRESS: STREET 1: 6530 POE AVENUE CITY: DAYTON STATE: OH ZIP: 45414 BUSINESS PHONE: 5138986070 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: FOLKERTH CAROLYN W CENTRAL INDEX KEY: 0001010313 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13D BUSINESS ADDRESS: STREET 1: 2230 SOUTH PATTERSON BLVD APT 11 CITY: DAYTON STATE: OH ZIP: 45409 BUSINESS PHONE: 5132983190 MAIL ADDRESS: STREET 1: 2230 SOUTH PATTERSON BLVD APT 11 CITY: DAYTON STATE: OH ZIP: 45409 SC 13D 1 SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13D 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) Patricia C. Norris, Esq., Thompson Hine & Flory P.L.L. 2000 Courthouse Plaza Northeast, Dayton, Ohio 45402 (513)443-6859 _________________________________________________________________ (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) March 7, 1996 _____________ (Date of Event which Requires Filing of this Statement) If the filing person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because or Rule 13d-1(b)(3) or (4), check the following box _. Check the following box if a fee is being paid with the statement X. (A fee is not required only if the reporting 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.) NOTE: Six copies of this statement, including all exhibits should be filed with the Commission. See Rule 13d-1(a) for other parties to whom copies are to be sent. *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 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). (Continued on following page(s)) Page 1 of 4 Pages CUSIP NO. 825098 10 6 13D Page 2 of 4 Pages 1 NAME OF REPORTING PERSON Carolyn W. Folkerth S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON ###-##-#### 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) _ (b) _ 3 SEC USE ONLY 4 SOURCE OF FUNDS* OO 5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e) _ 6 CITIZENSHIP OR PLACE OF ORGANIZATION U.S.A. NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH 7 SOLE VOTING POWER -0- 8 SHARED VOTING POWER 228,507 9 SOLE DISPOSITIVE POWER -0- 10 SHARED DISPOSITIVE POWER 228,507 11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 228,507 12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES* 13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 8.6% 14 TYPE OF REPORTING PERSON* IN *SEE INSTRUCTION BEFORE FILLING OUT! CUSIP NO. 825098 10 6 13D Page 3 of 4 Pages Item 1. Security and Issue _______ __________________ (a) Name of Issuer: Shopsmith, Inc. (b) Address of Issuer's Principal Executive Offices: 6530 Poe Avenue Dayton, Ohio 45414 Item 2. Identity and Background _______ _______________________ (a) Name of Person Filing: Carolyn W. Folkerth (b) Residence Address: 2230 Patterson Blvd., Apt. 11 Dayton, Ohio 45409 (c) Principal Occupation and Employer Address: None (d) Criminal Convictions: None (e) Securities Law Violations: None (f) Citizenship: United States of America Item 3. Source and Amount of Funds or Other Consideration _______ _________________________________________________ Acquisition of securities necessitating this filing were received as a gift. Item 4. Purpose of Transaction _______ ______________________ To hold shares for investment. CUSIP NO. 825098 10 6 13D Page 4 of 4 Pages Item 5. Interest in Securities of the Issuer _______ ____________________________________ (a) Number and Percentage of Securities Owned: 228,507 Common Shares; 8.6% of Class (b) Number of Shares as to which Person has: (i) sole power to vote or to direct the vote: -0- (ii) shared power to vote or to direct the vote: 228,507 (iii) sole power to dispose or to direct the disposition of: -0- (iv) shared power to dispose or to direct the disposition of: 228,507 (c) Transactions in the last 60 days: Carolyn W. Folkerth received 195,000 Common Shares on March 7, 1996 as a gift. (d) Rights of Other Persons: Not applicable. (e) Cessation of Five Percent Ownership: Not applicable. Item 6. Contracts, Arrangements, Understandings or Relationships with _______ _____________________________________________________________ Respect to Securities of the Issuer ___________________________________ Carolyn W. Folkerth shares the power to vote and dispose of the Common Shares of the Company held in her name with her husband, John R. Folkerth. Item 7. Material to be Filed as Exhibits _______ ________________________________ 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: March 12, 1996 /s/ Carolyn W. Folkerth Carolyn W. Folkerth -----END PRIVACY-ENHANCED MESSAGE-----