-----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, CVrDt6wZrYEwDyCkhiibc8KvX3PfI/Xux1HYBOUCPstqOuvbsdr9IE4Zcd2ymvgK XaS4tBHv0M32NNGaXlCQDA== 0001193125-05-029606.txt : 20050214 0001193125-05-029606.hdr.sgml : 20050214 20050214173011 ACCESSION NUMBER: 0001193125-05-029606 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20050214 DATE AS OF CHANGE: 20050214 GROUP MEMBERS: LEE R. KEMBERLING FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: KEMBERLING LEE R CENTRAL INDEX KEY: 0001250103 FILING VALUES: FORM TYPE: SC 13G/A 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/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-50575 FILM NUMBER: 05612989 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/A 1 dsc13ga.htm SCHEDULE 13G/A Schedule 13G/A

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

SCHEDULE 13G

 

 

UNDER THE SECURITIES EXCHANGE ACT OF 1934

(Amendment No. 1)

 

 

 

SRI/Surgical Express, Inc.

(Name of Issuer)

 

Common Stock

(Title of Class of Securities)

 

 

78464W104

                                (CUSIP Number)                                

 

December 31, 2004

(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)

 

¨ Rule 13d-1(c)

 

x Rule 13d-1(d)

CUSIP NO. 78464W104    Page 2 of 6

 

  1  

NAME OF REPORTING PERSON

Lee R. Kemberling

I.R.S. IDENTIFICATION NO. OF ABOVE PERSON (ENTITIES ONLY)

 

    
  2  

CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP

(a)  x

(b)  ¨

    
  3  

SEC USE ONLY

 

    
  4  

CITIZENSHIP OR PLACE OF ORGANIZATION

 

            Florida Revocable Trust

    

NUMBER OF

SHARES

BENEFICIALLY

OWNED BY

EACH

REPORTING

PERSON

WITH

  

  5    SOLE VOTING POWER

 

  6    SHARED VOTING POWER

 

                546,012

  7    SOLE DISPOSITIVE POWER

 

  8    SHARED DISPOSITIVE POWER

 

                546,012

  9  

AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON

 

            546,012

    
10  

CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES

 

  

¨

 

11  

PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9

 

            8.7%

    
12  

TYPE OF REPORTING PERSON

 

            OO

    

CUSIP NO. 78464W104    Page 3 of 6

 

  1  

NAME OF REPORTING PERSON

Lee R. Kemberling Revocable Living Trust

I.R.S. IDENTIFICATION NO. OF ABOVE PERSON (ENTITIES ONLY)

 

  2  

CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP

(a)  x

(b)  ¨

    
  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

 

                42,000

  6    SHARED VOTING POWER

 

                546,012

  7    SOLE DISPOSITIVE POWER

 

                42,000

  8    SHARED DISPOSITIVE POWER

 

                546,012

  9  

AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON

 

            588,012

    
10  

CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES

 

  

¨

 

11  

PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9

 

            9.4%

    
12  

TYPE OF REPORTING PERSON

 

            IN

    

 

 

CUSIP NO. 78464W104    Page 4 of 6

 

Item 1.

  

(a)

    Name of Issuer:          
         SRI/Surgical Express, Inc.          

Item 1.

  

(b)

    Address of Issuer’s Principal Executive Offices:          
        

12425 Racetrack Road

Tampa, FL 33626

          

Item 2.

  

(a)

    Name of Person Filing:          
         (1)    Lee R. Kemberling Revocable Living Trust
         (2)    Lee R. Kemberling

Item 2.

  

(b)

    Address of Principal Business Office or if None, Residence:          
         (1)   

11500 47th Street North

Clearwater, Florida 33762-4955

         (2)   

11500 47th Street North

Clearwater, Florida 33762-4955

Item 2.

  

(c)

    Citizenship:          
         (1)    Florida Revocable Trust
         (2)    United States of America

Item 2.

  

(d)

    Title of Class of Securities:          
         Common Stock, $0.001 par value per share of the Issuer (the “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 5 of 6

 

Item 4.

    Ownership          
     Lee R. Kemberling Revocable Living Trust (“Kemberling Trust”) and Lee R. Kemberling (“Kemberling”) (collectively, the “Filing Persons”) believe that 6,262,524 shares of Common Stock were outstanding as of December 31, 2004. Based on such number of outstanding shares, the Filing Persons report the following holdings of Common Stock and corresponding percentage interest of total shares outstanding:          
     Kemberling Trust is currently the record owner of 546,012 shares of the Issuer’s Common Stock (8.7%). Kemberling, individually and as trustee, may be deemed to beneficially own all 546,012 shares of Common Stock held by the Kemberling Trust. Kemberling is not the record owner of any shares of Common Stock. Kemberling Trust and Kemberling share the power to vote and power to dispose of the 546,012 shares of the Issuer’s Common Stock owned by Kemberling Trust.          
     Kemberling also has beneficial ownership of an additional 42,000 shares by virtue of outstanding stock options granted to him by the Issuer which are currently exercisable or are exercisable within 60 days following the date of this Schedule 13G.          

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:          
     N/A          

Item 7.

    Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company:
     N/A

Item 8.

    Identification and Classification of Members of the Group:          
     See Item 2 and Item 4          

Item 9.

    Notice of Dissolution of Group:          
     N/A          

Item. 10.

    Certification:          
     N/A          

CUSIP NO. 78464W104    Page 6 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, 2005

 

LEE R. KEMBERLING REVOCABLE

LIVING TRUST

        
By:  

/s/ Lee R. Kemberling

          

/s/ Lee R. Kemberling

    Lee R. Kemberling, Trustee           Lee R. Kemberling, individually

 

 

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