-----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, RVaBJVvPGsByYxxWq18C3rmOO1OLrXjW7akJp8hnT3RQyhvIKDrYZTIngnhFAaZp mqnqgOaukXw8DRPf6KVy2A== 0001095811-01-500762.txt : 20010402 0001095811-01-500762.hdr.sgml : 20010402 ACCESSION NUMBER: 0001095811-01-500762 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20010330 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BSQUARE CORP /WA CENTRAL INDEX KEY: 0001054721 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 911650880 STATE OF INCORPORATION: WA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: SEC FILE NUMBER: 005-58461 FILM NUMBER: 1586469 BUSINESS ADDRESS: STREET 1: 3150 139TH AVE SE SUITE 500 CITY: BELLEVUE STATE: WA ZIP: 98005 BUSINESS PHONE: 4255195900 MAIL ADDRESS: STREET 1: 3150 139TH AVE SE SUITE 500 CITY: BELLEVUE STATE: WA ZIP: 98005 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: DOSSER ALBERT T CENTRAL INDEX KEY: 0001137045 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: C/O BSQUARE CORP STREET 2: 3150 139TH AVENUE SE STE 500 CITY: BELLEVUE STATE: WA ZIP: 98005 BUSINESS PHONE: 4255195963 MAIL ADDRESS: STREET 1: C/O BSQUARE CORP STREET 2: 3150 139TH AVENUE SE STE 500 SC 13G 1 v70358sc13g.txt SCHEDULE 13G 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 BSQUARE Corporation - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock - -------------------------------------------------------------------------------- (Title of Class of Securities) 11776U102 ------------------------------ (CUSIP Number) October 19, 1999 ------------------------------ (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) *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 2 - -------------------------------------------------------------------------------- CUSIP No. 11776U102 13G - -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSON S.S. or I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Albert T. Dosser - -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [ ] - -------------------------------------------------------------------------------- 3 SEC USE ONLY - -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States - -------------------------------------------------------------------------------- 5 SOLE VOTING POWER NUMBER OF 5,721,999 SHARES --------------------------------------------------------- BENEFICIALLY 6 SHARED VOTING POWER OWNED BY --------------------------------------------------------- EACH 7 SOLE DISPOSITIVE POWER REPORTING PERSON 5,721,999 WITH --------------------------------------------------------- 8 SHARED DISPOSITIVE POWER - -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 5,721,999 - -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 16.9% - -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* IN - -------------------------------------------------------------------------------- Page 2 of 5 3 SCHEDULE 13G ITEM 1(a) NAME OF ISSUER: This Schedule 13G relates to BSQUARE Corporation, a Washington corporation (the "Company"). ITEM 1(b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: The Company's principal executive offices are located at 3150 139th Ave SE Suite 500, Bellevue, Washington 98005. ITEM 2(a) NAME OF PERSON FILING This Schedule 13G relates to Albert T. Dosser. ITEM 2(b) ADDRESS OF PRINCIPAL BUSINESS OFFICE The business address of the reporting person is 3150 139th Ave SE Suite 500, Bellevue, Washington 98005. ITEM 2(c) CITIZENSHIP Mr. Dosser is a United States citizen. ITEM 2(d) TITLE OF CLASS OF SECURITIES: This Schedule 13G relates to the Company's common stock, no par value (the "Common Stock"). ITEM 2(e) CUSIP NUMBER: The CUSIP Number for the Company's Common Stock is 11776U102. ITEM 3 IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D-1(b), OR 13D-2(b) OR (c), CHECK WHETHER THE FILING PERSON IS A: (a) [ ] Broker or dealer registered under Section 15 of the Exchange Act; (b) [ ] Bank as defined in Section 3(a)(6) of the Exchange Act; (c) [ ] Insurance company as defined in Section 3(a)(19) of the Exchange Act; (d) [ ] Investment company registered under Section 8 of the Investment Company Act; (e) [ ] An investment adviser in accordance with Rule 13d-1(b)(1)(ii)(E); (f) [ ] An employee benefit plan or endowment fund in accordance with Rule 13d-1(b)(1)(ii)(F); (g) [ ] A parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G); (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; (f) [ ] Group, in accordance with Rule 13d-1(b)(1)(ii)(J). Not Applicable Page 3 of 5 4 ITEM 4 OWNERSHIP The following describes the ownership of Common Stock by Mr. Dosser as of December 31, 2000: (a) Amount beneficially owned: 5,721,999 (b) Percent of class: 16.9 % (c) Number of shares as to which such person has: (i) Sole power to vote or direct the vote: 5,721,999 (ii) Shared power to vote or to direct the vote: (iii) Sole power to dispose or to direct the disposition of: 5,721,999 (iv) Shared power to dispose or to direct the disposition of: 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 ITEM 10. CERTIFICATIONS: Not applicable Page 4 of 5 5 SIGNATURE After reasonable inquiry to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. Feb. 15, 2001 ------------------------ Date /s/ ALBERT T. DOSSER ------------------------ Signature Albert T. Dosser, Sr. VP ------------------------ Name/Title Page 5 of 5 -----END PRIVACY-ENHANCED MESSAGE-----