-----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, SCimS8XjidgvjIlFRFAXkk3ivbvjUj5ECBcySZVBMyhTYcWz5YUjXCwIRqoLUsVb SLhYBK2hz5AOiQ5FCVXsiQ== 0000898430-97-000713.txt : 19970222 0000898430-97-000713.hdr.sgml : 19970222 ACCESSION NUMBER: 0000898430-97-000713 CONFORMED SUBMISSION TYPE: SC 13G/A CONFIRMING COPY: PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970220 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MAXWELL SHOE CO INC CENTRAL INDEX KEY: 0000918578 STANDARD INDUSTRIAL CLASSIFICATION: FOOTWEAR, (NO RUBBER) [3140] IRS NUMBER: 042599205 STATE OF INCORPORATION: DE FISCAL YEAR END: 1031 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-43801 FILM NUMBER: 00000000 BUSINESS ADDRESS: STREET 1: 101 SPRAGUE STREET STREET 2: P O BOX 37 CITY: READVILLE STATE: MA ZIP: 02137 BUSINESS PHONE: 6173645090 MAIL ADDRESS: STREET 1: 101 SPRAGUE STREET STREET 2: P O BOX 37 CITY: READVILLE STATE: MA ZIP: 02137 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: BLUM BETTY ANN CENTRAL INDEX KEY: 0000939051 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: PO BOX 37 CITY: READVILLE STATE: MA ZIP: 02137-0037 MAIL ADDRESS: STREET 1: PO BOX 37 CITY: READVILLE STATE: MA ZIP: 02137-0037 SC 13G/A 1 AMENDMENT #1 TO SCHEDULE 13G SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 -------------------- SCHEDULE 13G (Rule 13d-102) INFORMATION STATEMENT PURSUANT TO RULES 13d-1 AND 13d-2 UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. 1)/1/ MAXWELL SHOE COMPANY INC. - -------------------------------------------------------------------------------- (Name of Issuer) Class A Common Stock - -------------------------------------------------------------------------------- (Title of Class of Securities) 577766 10 8 - -------------------------------------------------------------------------------- (CUSIP number) - --------------- /1/ 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 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). (Page 1 of 6 Pages) - ----------------------- --------------------- CUSIP NO. 577766 10 8 13G PAGE 2 OF 6 PAGES - ----------------------- --------------------- - ------------------------------------------------------------------------------ NAME OF REPORTING PERSONS 1 S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS Betty Ann Blum - ------------------------------------------------------------------------------ CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* 2 (a) [_] (b) [_] - ------------------------------------------------------------------------------ SEC USE ONLY 3 - ------------------------------------------------------------------------------ CITIZENSHIP OR PLACE OF ORGANIZATION 4 U.S.A. - ------------------------------------------------------------------------------ SOLE VOTING POWER 5 NUMBER OF 1,709,287 SHARES ----------------------------------------------------------- SHARED VOTING POWER BENEFICIALLY 6 -0- OWNED BY ----------------------------------------------------------- EACH SOLE DISPOSITIVE POWER 7 REPORTING 1,709,287 PERSON ----------------------------------------------------------- SHARED DISPOSITIVE POWER WITH 8 -0- - ------------------------------------------------------------------------------ AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 9 1,709,287 - ------------------------------------------------------------------------------ CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* 10 [_] - ------------------------------------------------------------------------------ PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 11 40.3% - ------------------------------------------------------------------------------ TYPE OF REPORTING PERSON* 12 IN (Individual) - ------------------------------------------------------------------------------ ITEM 1(a). NAME OF ISSUER: Maxwell Shoe Company Inc. ITEM 1(b). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: 101 Sprague Street Boston, Massachusetts 02136 ITEM 2(a). NAME OF PERSON FILING: Betty Ann Blum ITEM 2(b). ADDRESS OF PRINCIPAL BUSINESS OFFICE: Maxwell Shoe Company Inc. 101 Sprague Street Boston, Massachusetts 02136 ITEM 2(c). CITIZENSHIP: U.S. citizen ITEM 2(d). TITLE OF CLASS OF SECURITIES: Class A Common Stock, $.01 par value ("Class A Stock"). The Reporting Person is the record owner of shares of Class B Common Stock, $.01 par value ("Class B Stock"), which are not registered under Section 12 of the Securities Exchange Act of 1934 (the "Act"), but which are immediately convertible into an equal number of shares of Class A Stock. The Issuer's Class A Stock is registered under Section 12 of the Act. ITEM 2(e). CUSIP NUMBER: 577766 10 8 ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO RULES 13d-1(b), OR 13d- 2(b), CHECK WHETHER THE PERSON FILING IS A: (a) [_] Broker or dealer registered under Section 15 of the Act, (b) [_] Bank as defined in Section 3(a)(6) of the Act, (c) [_] Insurance Company as defined in Section 3(a)(19) of the Act, (d) [_] Investment Company registered under Section 8 of the Investment Company Act, Page 3 of 6 (e) [_] Investment Adviser registered under Section 203 of the Investment Advisers Act of 1940, (f) [_] Employee Benefit Plan, Pension Fund which is subject to the provisions of the Employee Retirement Income Security Act of 1974 or Endowment Fund; see 13d-1(b)(1)(ii)(F), (g) [_] Parent Holding Company, in accordance with Rule 13d- 1(b)(ii)(G); see Item 7, (h) [_] Group, in accordance with Rule 13d-1(b)(1)(ii)(H). ITEM 4. OWNERSHIP. (a) Amount beneficially owned: Betty Ann Blum owns stock options which are exercisable within 60 days into 16,150 shares of Class A Stock and directly beneficially owns 1,693,137 shares of Class B Stock. (b) Percent of class: If the shares of Class B Stock owned by Ms. Blum were converted into Class A Stock, together with the shares of Class A Stock to which she is entitled upon the exercise of stock options, Ms. Blum would own approximately 40.3% of the outstanding shares of Class A Stock. (c) Number of shares as to which such person has: (i) Sole power to vote or to direct the vote: 1,709,287 (ii) Shared power to vote or to direct the vote: 0 (iii) Sole power to dispose or to direct the disposition of: 1,709,287 (iv) Shared power to dispose or to direct the disposition of: 0 ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS. If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following [ ]. ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON. Not applicable. Page 4 of 6 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. Page 5 of 6 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. Dated: February 14, 1997 /s/ Betty Ann Blum ----------------------------------- Betty Ann Blum Page 6 of 6 -----END PRIVACY-ENHANCED MESSAGE-----