National Research Corporation
|
(Name of Issuer) |
Common Stock, $.001 par value |
(Title of Class of Securities) |
637372 10 3 |
(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) |
* The remainder of this cover page shall be filled out for a reporting persons 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 on 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).
(Continued on following
page(s) )
Page 1 of 5 Pages
CUSIP No. 637372 10 3
1 | NAME OF REPORTING PERSONS I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY) Michael D. Hays | |||
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 United States | |||
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH |
5
6 7 8 |
SOLE VOTING POWER
4,839,465 SHARED VOTING POWER -0- SOLE DISPOSITIVE POWER 4,839,465 SHARED DISPOSITIVE POWER -0- | ||
9 | AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 4,839,465 | |||
10 | CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS) |
[ ] | ||
11 | PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 67.6% | |||
12 | TYPE OF REPORTING PERSON (SEE INSTRUCTIONS) IN | |||
Page 2 of 5 Pages
CUSIP No. 637372 10 3
Item 1(a). | Name of Issuer: |
National Research Corporation |
Item 1(b). | Address of Issuer's Principal Executive Offices: |
1245
Q Street Lincoln, Nebraska 68508 |
Item 2(a). | Name of Person Filing: |
Michael D. Hays |
Item 2(b). | Address of Principal Business Office or, if none, Residence: |
1245
Q Street Lincoln, Nebraska 68508 |
Item 2(c). | Citizenship: |
United States |
Item 2(d). | Title of Class of Securities: |
Common Stock, $.001 par value |
Item 2(e). | CUSIP Number: |
637372 10 3 |
Item 3. | If this statement is filed pursuant to Rules 13d-1(b), or 13d-2(b) or (c), check whether the person filing is a: |
Not Applicable |
Item 4. | Ownership (as of December 31, 2004). |
(a) | Amount Beneficially Owned: 4,839,465 shares. |
(b) | Percent of Class: 67.6% |
Page 3 of 5 Pages
CUSIP No. 637372 10 3
(c) | Number of shares as to which such person has: |
(i) | sole
power to vote or to direct the vote 4,839,465 shares |
(ii) | shared
power to vote or to direct the vote 0 |
(iii) | sole
power to dispose or to direct the disposition of 4,839,465 shares |
(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 |
Item 10. | Certification. |
Not Applicable |
Page 4 of 5 Pages
CUSIP No. 637372 10 3
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.
January 31, 2005
Date
/s/ Michael D. Hays
Signature
Michael D. Hays
Name
Page 5 of 5 Pages