Schedule 13G

-----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, DSGLBKEe/g4yiSPbA0MTenBA5lrl/6NM2N/vMR4lRJw7eUw6Cx+vOOsQa++XKcL9 oNgxqSyulIeMILnNlQ4vpA== 0001193125-04-025258.txt : 20040217 0001193125-04-025258.hdr.sgml : 20040216 20040217172241 ACCESSION NUMBER: 0001193125-04-025258 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 2 FILED AS OF DATE: 20040217 GROUP MEMBERS: PETERSON HOLDINGS, INC. GROUP MEMBERS: PETERSON PARTNERS, LTD. FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: PETERSON WAYNE R CENTRAL INDEX KEY: 0001250095 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: C/O SRI SURGICAL EXPRESS INC STREET 2: 1245 RACETRACK ROAD CITY: TAMPA STATE: FL ZIP: 33626 BUSINESS PHONE: 7727941414 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SRI SURGICAL EXPRESS INC CENTRAL INDEX KEY: 0001014041 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PERSONAL SERVICES [7200] IRS NUMBER: 593252632 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-50575 FILM NUMBER: 04610345 BUSINESS ADDRESS: STREET 1: 12425 RACETRACK ROAD CITY: TAMPA STATE: FL ZIP: 33626 BUSINESS PHONE: 8138919550 MAIL ADDRESS: STREET 1: 12425 RACETRACK ROAD CITY: TAMPA STATE: FL ZIP: 33626 FORMER COMPANY: FORMER CONFORMED NAME: STERILE RECOVERIES INC DATE OF NAME CHANGE: 19960511 SC 13G 1 dsc13g.htm SCHEDULE 13G Schedule 13G

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

SCHEDULE 13G

Under the Securities Exchange Act of 1934

SRI/Surgical Express, Inc.

(Name of Issuer)

Common Stock

(Title of Class of Securities)

78464W104

(CUSIP Number)

December 31, 2003

(Date of Event Which Requires Filing of this Statement)

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

¨ Rule 13d-1(b)

x Rule 13d-1(c)

¨ Rule 13d-1(d)


CUSIP NO. 78464W104		Page 2 of 8



1.		Name of Reporting Person I.R.S. Identification No. of above person (entities only) Wayne R. Peterson

2.		Check the Appropriate Box if a Member of a Group (a) ¨ (b) ¨

3.		SEC Use Only

4.		Citizenship or Place of Organization U.S.A.

NUMBER OF

BENEFICIALLY

OWNED BY

EACH

REPORTING

PERSON

WITH

5. Sole Voting Power

823,722

6. Shared Voting Power

7. Sole Dispositive Power

823,722

8. Shared Dispositive Power


9.		Aggregate Amount Beneficially Owned by Each Reporting Person 879,200

10.		Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares ¨

11.		Percent of Class Represented by Amount in Row 9 14.0%

12.		Type of Reporting Person IN


CUSIP NO. 78464W104		Page 3 of 8



1.		Name of Reporting Person I.R.S. Identification No. of above person (entities only) Peterson Partners, Ltd.

2.		Check the Appropriate Box if a Member of a Group (a) ¨ (b) ¨

3.		SEC Use Only

4.		Citizenship or Place of Organization Colorado

NUMBER OF

BENEFICIALLY

OWNED BY

EACH

REPORTING

PERSON

WITH

5. Sole Voting Power

737,200

6. Shared Voting Power

7. Sole Dispositive Power

737,200

8. Shared Dispositive Power


9.		Aggregate Amount Beneficially Owned by Each Reporting Person 737,200

10.		Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares ¨

11.		Percent of Class Represented by Amount in Row 9 11.8%

12.		Type of Reporting Person PN


CUSIP NO. 78464W104		Page 4 of 8



1.		Name of Reporting Person I.R.S. Identification No. of above persons (entities only) Peterson Holdings, Inc.

2.		Check the Appropriate Box if a Member of a Group (a) ¨ (b) ¨

3.		SEC Use Only

4.		Citizenship or Place of Organization Colorado

NUMBER OF

BENEFICIALLY

OWNED BY

EACH

REPORTING

PERSON

WITH

5. Sole Voting Power

737,200

6. Shared Voting Power

7. Sole Dispositive Power

737,200

8. Shared Dispositive Power


9.		Aggregate Amount Beneficially Owned by Each Reporting Person 737,200

10.		Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares ¨

11.		Percent of Class Represented by Amount in Row 9 11.8%

12.		Type of Reporting Person CO


CUSIP NO. 78464W104		Page 5 of 8

Item 1.

(a)

Name of Issuer:

SRI/Surgical Express, Inc.

(b)

Address of Issuer’s Principal Executive Offices:

12425 Racetrack Road

Tampa, FL 33626

Item 2.

(a)

Name of Person Filing:

(1)

Wayne R. Peterson

(2)

Peterson Partners, Ltd.

(3)

Peterson Holdings, Inc.

Item 2.

(b)

Address of Principal Business Office or if None, Residence:

(1)

2779 Camden Road

Clearwater, Florida 33759

(2)

700 N. Colorado Blvd., PMB 323

Denver, CO 80206-4036

(3)

700 N. Colorado Blvd., PMB 323

Denver, CO 80206-4036

Item 2.

(c)

Citizenship:

(1)

United States of America

(2)

Colorado

(3)

Colorado

Item 2.

(d)

Title of Class of Securities:

Common Stock

Item 2.

(e)

CUSIP Number:

78464W104

Item 3.

Statements filed pursuant to Rule 13d-1(b), or 13d-2(b) or (c):

N/A


CUSIP NO. 78464W104				Page 6 of 8



Item 4.	Ownership.

	(a)	Amount beneficially owned (describe): (1) 879,200* (2) 737,200 (3) 737,200 *This amount includes (1) 55,478 shares of Common Stock owned by the Wayne R. Peterson Grantor Retained Annuity Trust, of which Mr. Peterson is trustee, (2) 55,478 shares of Common Stock owned by the Theresa A. Peterson Grantor Retained Annuity Trust, of which Mrs. Peterson, Mr. Peterson’s wife, is trustee, (3) 31,044 shares of Common Stock owned by Mr. and Mrs. Peterson as tenants by the entireties, and (4) 737,200 shares of Common Stock owned by Peterson Partners, Ltd., a Colorado limited partnership of which Peterson Holdings, Inc., a Colorado corporation, is the general partner. Mr. and Mrs. Peterson jointly own all of the issued and outstanding voting stock of Peterson Holdings, Inc.

	(b)	Percent of class: (1) 14.0% (2) 11.8% (3) 11.8%

	(c)	Number of shares as to which the person has: (1):

		(i)	Sole power to vote or to direct the vote: 823,722**

		(ii)	Shared power to vote or to direct the vote: .

		(iii)	Sole power to dispose or to direct the disposition of: 823,722**

		(iv)	Shared power to dispose or to direct the disposition of: . **These amounts exclude 55,478 shares of Common Stock owned by the Theresa A. Peterson Grantor Retained Annuity Trust, as to which Mrs. Peterson has sole voting and dispositive power as trustee.


CUSIP NO. 78464W104				Page 7 of 8



	(2):

		(i)	Sole power to vote or to direct the vote: 737,200

		(ii)	Shared power to vote or to direct the vote: .

		(iii)	Sole power to dispose or to direct the disposition of: 737,200

		(iv)	Shared power to dispose or to direct the disposition of: .

	(3):

		(i)	Sole power to vote or to direct the vote: 737,200

		(ii)	Shared power to vote or to direct the vote: .

		(iii)	Sole power to dispose or to direct the disposition of: 737,200

		(iv)	Shared power to dispose or to direct the disposition of: .

Item 5.	Ownership of Five Percent or Less of a Class: N/A

Item 6.	Ownership of More than Five Percent on Behalf of Another Person: Theresa A. Peterson, Mr. Peterson’s wife, has the power to direct the receipt of dividends from, or the proceeds from the sale of, (1) 55,478 shares of Common Stock owned by the Theresa A. Peterson Grantor Retained Annuity Trust, of which Mrs. Peterson is trustee, (2) 31,044 shares of Common Stock owned by Mr. and Mrs. Peterson as tenants by the entireties, which power is shared with Mr. Peterson, and (3) 737,200 shares of Common Stock owned by Peterson Partners, Ltd., which power is shared with Mr. Peterson.

Item 7.	Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company: N/A


CUSIP NO. 78464W104				Page 8 of 8



Item 8.		Identification and Classification of Members of the Group: N/A

Item 9.		Notice of Dissolution of Group: N/A

Item 10.		Certification: By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of such securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.

Exhibit:

Exhibit 1: Joint Filing Agreement

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 13, 2004


/s/ WAYNE R. PETERSON		PETERSON PARTNERS, LTD.
WAYNE R. PETERSON

		By:	Peterson Holdings, Inc., its general partner

		By:	/s/ WAYNE R. PETERSON

			Wayne R. Peterson, President

PETERSON HOLDINGS, INC

By:	/s/ WAYNE R. PETERSON
	Wayne R. Peterson, President

EX-1 3 dex1.htm JOINT FILING AGREEMENT Joint Filing Agreement

Exhibit 1

JOINT FILING AGREEMENT

The undersigned hereby agree to file jointly the statement on Schedule 13G to which this Agreement is attached and any amendments thereto which may be deemed necessary, pursuant to Regulation 13D-G under the Securities Exchange Act of 1934.

It is understood and agreed that each of the parties hereto is responsible for the timely filing of such statement and any amendments thereto and for the completeness and accuracy of the information concerning such party contained therein, but such party is not responsible for the completeness or accuracy of information concerning the other party unless such party knows or has reason to believe that such information is inaccurate.

It is understood and agreed that a copy of this Agreement shall be attached as an exhibit to the statement on Schedule 13G, and any amendments hereto, filed on behalf of each of the parties hereto.

Dated: February 13, 2004


/s/ WAYNE R. PETERSON		PETERSON PARTNERS, LTD.
WAYNE R. PETERSON

		By:	Peterson Holdings, Inc., its general partner

		By:	/s/ WAYNE R. PETERSON

			Wayne R. Peterson, President

PETERSON HOLDINGS, INC

By:	/s/ WAYNE R. PETERSON
	Wayne R. Peterson, President

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