-----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, WdqLkWas5MuwhQl2a6b322ONNb2G3lOvrrzY4/yYEeDwBtZVfTjslmf1qQeso4wt AsZ+uh/wOFOxBi4OEz0wSg== 0000912057-01-004200.txt : 20010208 0000912057-01-004200.hdr.sgml : 20010208 ACCESSION NUMBER: 0000912057-01-004200 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20010207 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: COMMUNITY FIRST BANKSHARES INC CENTRAL INDEX KEY: 0000857593 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 460391436 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: SEC FILE NUMBER: 005-48511 FILM NUMBER: 1527260 BUSINESS ADDRESS: STREET 1: 520 MAIN AVENUE CITY: FARGO STATE: ND ZIP: 58124-0001 BUSINESS PHONE: 7012985600 MAIL ADDRESS: STREET 1: 520 MAIN AVENUE CITY: FARGO STATE: ND ZIP: 58124-0001 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: MATHISEN DENNIS M CENTRAL INDEX KEY: 0001038601 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 8433 E CAREFREE DRIVE STREET 2: P O BOX 5511 CITY: CAREFREE STATE: AZ ZIP: 85377 SC 13G 1 a2037334zsc13g.txt SC 13G SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. __) COMMUNITY FIRST BANKSHARES, INC. -------------------------------------------- (Name of Issuer) COMMON STOCK, PAR VALUE $.01 PER SHARE -------------------------------------------- (Title of Class of Securities) 203902101 -------------------------------------------- (CUSIP Number) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: / / Rule 13d-1(b) / / 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 ("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. 203902101 13G Page 2 of 5 Pages ---------------- ------- ------- - ------------------------------ ---------------------------------- - -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSON: Dennis M. Mathisen I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (entities only): - -------------------------------------------------------------------------------- 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 Minnesota - -------------------------------------------------------------------------------- 5 SOLE VOTING POWER NUMBER OF 2,126,510 SHARES ---------------------------------------- BENEFICIALLY 6 SHARED VOTING POWER OWNED BY EACH ---------------------------------------- 7 SOLE DISPOSITIVE POWER REPORTING 2,126,510 PERSON ---------------------------------------- WITH: 8 SHARED DISPOSITIVE POWER - -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 2,126,510 - -------------------------------------------------------------------------------- 10 CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (See Instructions) / / - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 5.08% - -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON (See Instructions) IN - -------------------------------------------------------------------------------- Page 3 of 5 Pages ITEM 1. (a) NAME OF ISSUER The name of the issuer is Community First Bankshares, Inc. (b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES The address of the principal executive offices of the Issuer is 520 Main Avenue, Fargo, North Dakota 58124-0001. ITEM 2. (a) NAME OF PERSON FILING. This statement is being filed by Dennis M. Mathisen. (b) ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE. The principal address of the Reporting Person is: 903 North Third Street, Suite 300, Minneapolis, Minnesota 55402. (c) CITIZENSHIP. Minnesota (d) TITLE OF CLASS OF SECURITIES. Common Stock, par value $.01 per share (e) CUSIP NUMBER. 203902101 ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 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 (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 Section 240.13d-1(b)(1)(ii)(F) Page 4 of 5 Pages (g) / / Parent Holding Company, in accordance with Section 240.13d-1(b)(ii)(G) (Note: See Item 7) (h) / / A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act. (i) / / A church plan that is excluded from the definition of an investment. company under Section 3(c)(14) of the Investment Company Act of 1940. (j) / / Group in accordance with Section 240.13d-1(b)(1)(ii) (J). ITEM 4. OWNERSHIP At December 31, 2000, the beneficial ownership of shares of the Reporting Person was as follows: (a) Amount beneficially owned: 2,126,510* (b) Percent of Class: 5.08% (c) Number of shares as to which the person has: (i) Sole power to vote or direct the vote: 2,126,510* (ii) Shared power to vote or direct the vote: 0 (iii) Sole power to dispose or direct the disposition of: 2,126,510* (iv) Shared power to dispose or direct the disposition of: 0 - -------------------------- * Includes options to purchase 16,000 shares of common stock exercisable within 60 days. 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 REPORTED ON BY THE PARENT HOLDING COMPANY. Not Applicable Page 5 of 5 Pages ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP Not Applicable ITEM 9. NOTICE OF DISSOLUTION OF GROUP Not Applicable ITEM 10. CERTIFICATION (a) Not Applicable (b) Not Applicable. 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 6, 2001 /s/ Dennis M. Mathisen ---------------------------- DENNIS M. MATHISEN -----END PRIVACY-ENHANCED MESSAGE-----