-----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, T9VtQCtLDK7k3zDRM1WGKLMzRTCdw63qHIpDC67vRcCTARUD01GGR0wv4X89tPCV xgwaPvRNLJvk9SKovR6xFg== 0000912057-02-005589.txt : 20020414 0000912057-02-005589.hdr.sgml : 20020414 ACCESSION NUMBER: 0000912057-02-005589 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20020213 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: BAILLY R JEFFREY CENTRAL INDEX KEY: 0001033284 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 172 EAST MAIN STREET CITY: GEORGETOWN STATE: MA ZIP: 01833 BUSINESS PHONE: 5083522200 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: UFP TECHNOLOGIES INC CENTRAL INDEX KEY: 0000914156 STANDARD INDUSTRIAL CLASSIFICATION: PLASTICS FOAM PRODUCTS [3086] IRS NUMBER: 042314970 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-45218 FILM NUMBER: 02540776 BUSINESS ADDRESS: STREET 1: 172 EAST MAIN ST CITY: GEORGETOWN STATE: MA ZIP: 01833 BUSINESS PHONE: 5083522200 MAIL ADDRESS: STREET 1: 172 EAST MAIN ST CITY: GEORGETOWN STATE: MA ZIP: 02135 SC 13G/A 1 a2070525zsc13ga.txt SC 13G/A UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. 1)* UFP TECHNOLOGIES, INC. ---------------------- (Name of Issuer) COMMON STOCK - $.01 PAR VALUE 902673102 --------- (CUSIP Number) DECEMBER 31, 2001 --------------------------- 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) [x ] Rule 13d-1(c) [ ] 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 (the "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 5 Pages =============================================================================== CUSIP No. 902673102 Page 2 of 5 pages =============================================================================== SCHEDULE 13G AMENDMENT NO. 1 1) Names of Reporting Persons; S.S. or I.R.S. Identification Nos. of Above Persons R. JEFFREY BAILLY --------------------------------------------------------------------------- 2) Check the Appropriate Box if a Member of a Group (See Instructions) (a) ------------------------------------------------------------------------ (b) ------------------------------------------------------------------------ 3) SEC Use Only -------------------------------------------------------------- 4) Citizenship or Place of Organization U.S.A. ------------------------------------- Number of Shares 5) Sole Voting Power 661,098 ------------------------------- Beneficially Owned By Each Reporting 6) Shared Voting Power 120,090 ------------------------------- Person With 7) Sole Dispositive Power 661,098 --------------------------- 8) Shared Dispositive Power 120,090 -------------------------
9) Aggregate Amount Beneficially Owned by Each Reporting Person 781,188 --------------------------------------------------------------------------- 10) Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) -------------------------------------------------------- 11) Percent of Class Represented by Amount in Row (9) 16.9% ------------------------ 12) Type of Reporting Person (See Instructions) IN -------------------------- =============================================================================== CUSIP No. 902673102 Page 3 of 5 pages =============================================================================== SECURITIES AND EXCHANGE COMMISSION SCHEDULE 13G AMENDMENT NO. 1 Item 1(a) Name of Issuer: UFP Technologies, Inc. (b) Address of Issuer's Principal Executive Offices: 172 East Main Street Georgetown, Massachusetts 01833 Item 2(a) Name of Person Filing: R. Jeffrey Bailly (b) Address of Principal Business Office or, if none, Residence: 172 East Main Street Georgetown, Massachusetts 01833 (c) Citizenship: USA (d) Title of Class of Securities: Common Stock, $.01 par value (e) CUSIP NUMBER: 902673102 Item 3 If this statement is filed pursuant to Sections 240.13d-1(b), or 240.13d-2(b) or (c), check whether the person filing is a: (a) [ ] Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o). (b) [ ] Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c). (c) [ ] Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c). (d) [ ] Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8). (e) [ ] An investment advisor in accordance with Section 240.13d-1(b)(1)(ii)(E). (f) [ ] An employee benefit plan or endowment fund in accordance with Section 240.13d-1(b)(1)(ii)(F). (g) [ ] A parent holding company or control person in accordance with Section 240.13d-1(b)(1)(ii)(G). (h) [ ] A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813); (i) [ ] A church plan that is excluded from the definition if an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3); (j) [ ] Group, in accordance with Section 240.13d-1(b)(1)(ii)(J).
=============================================================================== CUSIP No. 902673102 Page 4 of 5 pages =============================================================================== Item 4 (a) Amount Beneficially Owned: 781,188 (b) Percent of Class: 16.9% (c) Number of Shares as to which such person has: (i) sole power to direct the vote 661,098 (ii) shared power to vote or to direct the vote 120,090 (iii) sole power to dispose or to direct the disposition of 661,098 (iv) shared power to dispose or to direct the disposition of 120,090
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 Item 9 Notice of Dissolution of Group: Not Applicable =============================================================================== CUSIP No. 902673102 Page 5 of 5 pages =============================================================================== Item 10 Certification (a) Not Applicable (b) By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as participant in any transaction having that purpose or effect. After reasonable inquiry and to the best of my knowledge and belief, I hereby certify that the information set forth in this statement is true, complete and correct. February 12, 2002 -------------------------------------- Date /s/ R. Jeffrey Bailly -------------------------------------- Signature R. Jeffrey Bailly -------------------------------------- Name/Title -----END PRIVACY-ENHANCED MESSAGE-----