-----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, B9FI4VgdTuHYZFtgVXjn6oeFLn7sz61dgqnYQGFd+60OlqikDQTt9QsQcqdJrNB2 qk0NVHZgfYGrChPTOefpHQ== 0000912057-97-005113.txt : 19970222 0000912057-97-005113.hdr.sgml : 19970222 ACCESSION NUMBER: 0000912057-97-005113 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970213 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: NORTHSTAR COMPUTER FORMS INC/MN CENTRAL INDEX KEY: 0000873082 STANDARD INDUSTRIAL CLASSIFICATION: MANIFOLD BUSINESS FORMS [2761] IRS NUMBER: 410882640 STATE OF INCORPORATION: MN FISCAL YEAR END: 1031 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-42220 FILM NUMBER: 97531567 BUSINESS ADDRESS: STREET 1: 7130 NORTHLAND CIRCLE NORTH CITY: BROOKLYN PARK STATE: MN ZIP: 55428-1530 BUSINESS PHONE: 6123388601 MAIL ADDRESS: STREET 1: 7130 NORTHLAND CIRCLE NORTH CITY: BROOKLYN PARK STATE: MN ZIP: 55428-1530 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: BREDESEN ROGER T CENTRAL INDEX KEY: 0001033262 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 7130 NORTHLAND CIRCLE NORTH CITY: BROOKLYN PARK STATE: MN ZIP: 55428 BUSINESS PHONE: 6123332111 SC 13G/A 1 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)* Northstar Computer Forms, Inc. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock, Par Value $.05 Per Share - -------------------------------------------------------------------------------- (Title of Class of Securities) 667031 - -------------------------------------------------------------------------------- (CUSIP Number) Check the following box if a fee is being paid with this statement. / / (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). CUSIP No. 667031 - ------------------------------------------------------------------------------- (1) Names of Reporting Persons. S.S. or I.R.S. Identification Nos. of Above Persons Roger T. Bredsen - ------------------------------------------------------------------------------- (2) Check the Appropriate Box if a Member (a) / / of a Group* (b) / / - ------------------------------------------------------------------------------- (3) SEC Use Only - ------------------------------------------------------------------------------- (4) Citizenship or Place of Organization United States - ------------------------------------------------------------------------------- Number of Shares (5) Sole Voting Beneficially Power 101,633 Owned by -------------------------------------------------- Each Reporting (6) Shared Voting Person With Power 0 -------------------------------------------------- (7) Sole Dispositive Power 101,633 -------------------------------------------------- (8) Shared Dispositive Power 0 - ------------------------------------------------------------------------------- (9) Aggregate Amount Beneficially Owned by Each Reporting Person 101,633(1) - ------------------------------------------------------------------------------- (10) Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares* - ------------------------------------------------------------------------------- (11) Percent of Class Represented by Amount in Row (9) 6.0% - ------------------------------------------------------------------------------- (12) Type of Reporting Person* IN - ------------------------------------------------------------------------------- - -------------- (1) Includes 17,167 shares issuable upon exercise of currently exercisable options. *SEE INSTRUCTION BEFORE FILLING OUT! Item 1. (a) NAME OF ISSUER: Northstar Computer Forms, Inc. (b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: 7130 Northland Circle North, Brooklyn Park, Minnesota, 55428 Item 2. (a) NAME OF PERSON FILING: Roger T. Bredesen (b) ADDRESS OF PRINCIPAL OFFICE OR, IF NONE, RESIDENCE: 7130 Northland Circle North, Brooklyn Park, Minnesota, 55428 (c) CITIZENSHIP: United States (d) TITLE OF CLASS OF SECURITIES: Common Stock, par value $.05 per share (e) CUSIP NO.: 667031 Item 3. IF THIS STATEMENT IS FILED PURSUANT TO RULES 13d-1(b), OR 13d-2(b), CHECK WHETHER THE PERSON FILING IS A: NA Item 4. OWNERSHIP: (a) AMOUNT BENEFICIALLY OWNED: 101,633 Shares, 17,167 of which are purchaseable upon exercise of currently exercisable options. (b) PERCENT OF CLASS: 6.0% (c) NUMBER OF SHARES AS TO WHICH PERSON HAS: (i) Sole power to vote or to direct the vote: 101,633 (ii) Shared power to vote or to direct the vote: 0 (iii) Sole power to dispose or to direct the disposition of: 101,633 (iv) Shared power to dispose or to direct the disposition of: 0 Item 5. OWNERSHIP OF 5% OR LESS OF A CLASS: NA Item 6. OWNERSHIP OF MORE THAN 5% ON BEHALF OF ANOTHER PERSON: NA Item 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY: NA Item 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP: NA Item 9. NOTICE OF DISSOLUTION OF GROUP: NA Item 10. CERTIFICATION: NA 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 12, 1997 /s/ Roger T. Bredesen ------------------------------------- Signature By: Mary Ann Morin, Attorney-in-fact --------------------------------- -----END PRIVACY-ENHANCED MESSAGE-----