-----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, EjWmYjTiT87ehc2dQXnDSuvgsUrGhmQBFuZ27jWJLjs/Y6vPImf6TObZvuWhL8rh AGWDgoxvh8Ds65fB1w4ZNw== 0000827056-97-000024.txt : 19971003 0000827056-97-000024.hdr.sgml : 19971003 ACCESSION NUMBER: 0000827056-97-000024 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19971002 SROS: AMEX SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ZEVEX INTERNATIONAL INC CENTRAL INDEX KEY: 0000827056 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 870462807 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D SEC ACT: SEC FILE NUMBER: 005-51013 FILM NUMBER: 97689754 BUSINESS ADDRESS: STREET 1: 4314 ZEVEX PARK LANE CITY: MURRAY STATE: UT ZIP: 84123 BUSINESS PHONE: 8012641001 MAIL ADDRESS: STREET 1: 4314 ZEVEX PARK LANE CITY: MURRAY STATE: UT ZIP: 84123 FORMER COMPANY: FORMER CONFORMED NAME: DOWNEY INDUSTRIES INC DATE OF NAME CHANGE: 19880811 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: ANDERSON DOUGLAS CENTRAL INDEX KEY: 0001047024 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13D BUSINESS ADDRESS: STREET 1: 6263 SOUTH SHENANDOWAN PARK AVE CITY: SALT LAKE CITY STATE: UT ZIP: 84121 BUSINESS PHONE: 8019778000 MAIL ADDRESS: STREET 1: 6263 SOUTH SHENANDOWAN PARK AVE CITY: SALT LAKE CITY STATE: UT ZIP: 84121 SC 13D 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13D Under the Securities Exchange Act of 1934 ZEVEX International, Inc. (Name of Issuer) Common Stock $.04 par value (Title of Class of Securities) 98950E400 (CUSIP Number) Elaine Coffey ZEVEX International, Inc. 4314 ZEVEX Park Lane Salt Lake City, UT 84123 (801) 264-1001, xt. 215 (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) May 19, 1997 (Dates of Event which Requires Filing of this Statement) If the filing person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because of Rule 13d- 1(b)(3) or (4), check the following box . Check the following box if a fee is being paid with the statement. SCHEDULE 13D CUSIP No. 98950E400 Page 2 of 4 Pages 1 NAME OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Douglas Anderson 529 17 6626 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a) (b) 3 SEC USE ONLY 4 SOURCE OF FUNDS PF 5 CCHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e) 6 CITIZENSHIP OR PLACE OF ORGANIZATION USA NUMBER OF SHARES OWNED BY EACH REPORTING PERSON WITH 7 SOLE VOTING POWER 130,000 8 SHARED VOTING POWER 9 SOLE DISPOSITIVE POWER 130,000 10 SHARED DISPOSITIVE POWER 11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 130,000 12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES* 13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 6.39% 14 TYPE OF REPORTING PERSON* IN *SEE INSTRUCTIONS BEFORE FILLNG OUT! INCLUDE BOTH SIDES OF THE COVER PAGE, RESPONSES TO ITEMS 1-7 (INCLUDING EXHIBITS) OF THE SCHEDULE, AND THE SIGNATURE ATTESTATION. Item 1. Security and Issuer This statement relates to shares of common stock, $.04 par value (the "Common Stock") of ZEVEX International, Inc. (ZVX). ZEVEX's principal executive office is located at 4314 ZEVEX Park Lane, Salt Lake City, UT 84123. Item 2. Identity and Background This statement is being filed on behalf of Douglas Anderson, an Individual. Mr. Anderson's principal address is 6263 South Shenandowah Park Lane, Salt Lake City, Ut, 84121. Mr. Anderson has not, during the last five years, been convicted in a criminal proceeding (excluding traffic violations or similar misdemeanors). Mr. Anderson has not, during the last five years, been a party to a civil proceeding of a judicial or administrative body competent jurisdiction which resulted in a judgment, decree of final order enjoining future violations of, or prohibiting of mandating activities subject to, federal or state securities laws or finding any violations with respect to such laws. Mr. Anderson is a citizen of United States of America. Item 3. Source and Amount of Funds of Other Consideration. As of the date hereof, Mr. Anderson is deemed to beneficially own 130,000 shares of Common Stock, 130,000 shares of Common Stock which were received in a stock for land transaction in October of 1996. All shares were obtained with personal assets of the filing Person. Item 4. Purpose of Transaction. The shares of Common Stock deemed to be beneficially owned by Mr. Anderson were acquired for, and are being held for, investment purposes. Mr. Anderson has no plan or proposal which relates to, or would result in, any of the actions enumerated in Item 4 of the instructions of Schedule 13D. Item 5. Interest in Securities of Issuer. As of the date hereof, Mr. Anderson is deemed to be the beneficial owner of 130,000 shares of Common Stock. Based on ZEVEX International, Inc. filing on Schedule 10Q on May 15, 1997, as of May 12, 1997, there were 1,995,716 shares of Common Stock issued and outstanding. Therefore, Mr. Anderson is deemed to beneficially own 6.39% of the issued and outstanding shares of Common Stock. Mr. Anderson has the sole power to vote, direct to vote, dispose of, or direct the deposition of all the shares of Common Stock that he is currently deemed to beneficially own. Item 6. Contracts, Arrangements, Understandings or Relationships with Respect to Securities of the Issuer. Mr. Anderson has no contracts, arrangements, understandings of relationships with respect to Common Stock. Item 7. Material to be filed as Exhibits. None Signature The undersigned, after reasonable inquiry and to the best of my knowledge and belief, certifies that the information set forth in this statement is true, correct and complete. /s/Douglas Anderson -----END PRIVACY-ENHANCED MESSAGE-----