-----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, IN3RujvgaakJD/hcfmZPwZz8srCVi4k3lIFX3lTmeDEDM+pJhMdyaM5Vg0REMbrL 5uXSrwxR9viwg50gJUpj7w== 0000950135-97-000647.txt : 19970222 0000950135-97-000647.hdr.sgml : 19970222 ACCESSION NUMBER: 0000950135-97-000647 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970214 SROS: NASD 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: 005-44833 FILM NUMBER: 97533132 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 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: BAILLY RICHARD L CENTRAL INDEX KEY: 0000938661 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 172 EAST MAIN STREET CITY: GEORGETOWN STATE: MA ZIP: 01833 BUSINESS PHONE: 5083522200 SC 13G/A 1 RICHARD L. BAILLY AMENDMENT NO 3 TO SC 13G 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. 3) UFP Technologies, Inc. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock - $.01 Par Value - -------------------------------------------------------------------------------- 902673102 - -------------------------------------------------------------------------------- (CUSIP Number) 2 SCHEDULE 13G CUSIP No. 902673102 1) Names of Reporting Persons; S.S. or I.R.S. Identification Nos. of Above Persons Richard L. 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 268,068 -------------------------------- Beneficially Owned 6) Shared Voting Power 175,924 By Each Reporting ------------------------------ Person With 7) Sole Dispositive Power 268,068 --------------------------- 8) Shared Dispositive Power 175,924 ------------------------- 9) Aggregate Amount Beneficially Owned by Each Reporting Person 443,992 --------------------------------------------------------------------------- 10) Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) --------------------------------------------------------------------------- 11) Percent of Class Represented by Amount in Row (9) 9.5% -------------------------- 12) Type of Reporting Person (See Instructions) IN -------------------------------- -2- 3 SECURITIES AND EXCHANGE COMMISSION SCHEDULE 13G AMENDMENT NO. 3 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: Richard L. 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 Rule 13d-1(b), or 13d-2(b), check whether the person filing is a: Not Applicable Item 4(a) Amount Beneficially Owned: 443,992 (b) Percent of Class: 9.5% (c) Number of Shares as to which such person has: (i) sole power to direct the vote 268,068 (ii) shared power to vote or to direct the vote 175,924 -3- 4 (iii) sole power to dispose or to direct the disposition of 268,068 (iv) shared power to dispose or to direct the disposition of 175,924 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 Item 10 Certification Not Applicable -4- 5 SIGNATURE 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 10, 1997 --------------------------- Date /s/ Richard L. Bailly --------------------------- Signature Richard L. Bailly --------------------------- Name/Title -5- -----END PRIVACY-ENHANCED MESSAGE-----