-----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, S59GhMtrgJu9oSTRd8bi9s1xOwjcb/N0iAvfFGlMg79vIndYiIihiU95Fj2K66Ws 1XD+72bh3dO+j2BkmPw14g== 0001104659-11-007396.txt : 20110214 0001104659-11-007396.hdr.sgml : 20110214 20110214164042 ACCESSION NUMBER: 0001104659-11-007396 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20110214 DATE AS OF CHANGE: 20110214 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: BAILLY R JEFFREY CENTRAL INDEX KEY: 0001033284 FILING VALUES: FORM TYPE: SC 13G/A 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: 11607833 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 a11-5852_1sc13ga.htm SC 13G/A

 

 

UNITED STATES

 

 

SECURITIES AND EXCHANGE COMMISSION

 

 

Washington, D.C. 20549

 

 

 

 

SCHEDULE 13G

Under the Securities Exchange Act of 1934

 

(Amendment No. 10)*

 

UFP Technologies, Inc.

(Name of Issuer)

Common Stock - $.01 Par Value

 

902673102

(CUSIP Number)

December 31, 2010

Date of Event Which Requires Filing of this Statement

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

o

Rule 13d-1(b)

o

Rule 13d-1(c)

x

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).

 



 

CUSIP No. 902673102

 

SCHEDULE 13G

Amendment No. 10

 

 

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)

o

 

 

(b)

o

 

 

3)

SEC Use Only

 

 

4)

Citizenship or Place of Organization
U.S.A.

 

 

 

Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With

5)

Sole Voting Power
1,021,180

 

6)

Shared Voting Power
0

 

7)

Sole Dispositive Power
1,021,180

 

8)

Shared Dispositive Power
0

 

 

9)

Aggregate Amount Beneficially Owned by Each Reporting Person
1,021,180

 

 

10)

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)  o

 

 

11)

Percent of Class Represented by Amount in Row (9)
15.5%

 

 

12)

Type of Reporting Person (See Instructions)
IN

 

2



 

CUSIP No. 902673102

 

SECURITIES AND EXCHANGE COMMISSION

 

SCHEDULE 13G

Amendment No. 10

 

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 §§240.13d-1(b), or 240.13d-2(b) or (c), check whether the person filing is a:

 

(a)

o

Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o).

 

(b)

o

Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c).

 

(c)

o

Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c).

 

(d)

o

Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8).

 

(e)

o

An investment advisor in accordance with §240.13d-1(b)(1)(ii)(E).

 

(f)

o

An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F).

 

(g)

o

A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G).

 

(h)

o

A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);

 

(i)

o

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)

o

Group, in accordance with § 240.13d–1(b)(1)(ii)(J).

 

3



 

CUSIP No. 902673102

 

Item 4

 

 

 

(a)

Amount beneficially owned:   

1,021,180

 

(b)

Percent of class:   

15.5%

 

(c)

Number of shares as to which such person has:

 

 

 

(i)

Sole power to direct the vote   

1,021,180

 

 

(ii)

Shared power to vote or to direct the vote    

0

 

 

(iii)

Sole power to dispose or to direct the disposition of   

1,021,180

 

 

(iv)

Shared power to dispose or to direct the disposition of   

0

 

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

 

4



 

CUSIP No. 902673102

 

Item 10

Certification

 

Not Applicable

 

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 14, 2011

 

Date

 


/s/ R. Jeffrey Bailly

 

Signature

 


R. Jeffrey Bailly

 

Name/Title

 

5


-----END PRIVACY-ENHANCED MESSAGE-----