-----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, Kr7BU53HTZyFB1IFo/gPwXSfJHcgb2qtgNJU8xVajS/2wh9G4yx4wSHFp9Cf4pBB 6LGvT1IOFW/mQ37q5pIQyg== 0000912057-97-007116.txt : 19970228 0000912057-97-007116.hdr.sgml : 19970228 ACCESSION NUMBER: 0000912057-97-007116 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970227 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CANTERBURY PARK HOLDING CORP CENTRAL INDEX KEY: 0000926761 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-RACING, INCLUDING TRACK OPERATION [7948] IRS NUMBER: 411775532 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-43299 FILM NUMBER: 97545217 BUSINESS ADDRESS: STREET 1: 1100 CANTERBURY DR CITY: SHAKOPEE STATE: MN ZIP: 55379 BUSINESS PHONE: 6124457223 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: SAMPSON CURTIS A CENTRAL INDEX KEY: 0000941310 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: PO BOX 777 STREET 2: 213 MAIN ST CITY: HECTOR STATE: MN ZIP: 55342 BUSINESS PHONE: 3208486231 MAIL ADDRESS: STREET 1: PO BOX 777 STREET 2: S MAIN ST CITY: HECTOR STATE: MN ZIP: 55342 SC 13G/A 1 SCHEDULE 13G/A SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. 2 )* Canterbury Park Holding Corporation - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock, Par Value $0.01 - -------------------------------------------------------------------------------- (Title of Class of Securities) 13811E 10 1 ---------------------------------------- (CUSIP Number) *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). (Continued on following page(s)) Page 1 of 4 --- --- CUSIP No. 13811E 10 1 13G Page 2 of 4 Pages ----------- --- --- - ------------------------------------------------------------------------------- (1) NAMES OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS Curtis A. Sampson ###-##-#### - ------------------------------------------------------------------------------- (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 of America - ------------------------------------------------------------------------------- Number of Shares (5) Sole Voting Power Beneficially 1,385,531 Owned by -------------------------------------------------- Each Reporting (6) Shared Voting Power Person With 0 -------------------------------------------------- (7) Sole Dispositive Power 1,385,531 -------------------------------------------------- (8) Shared Dispositive Power 0 - ------------------------------------------------------------------------------- (9) Aggregate Amount Beneficially Owned by Each Reporting Person 1,385,531 - ------------------------------------------------------------------------------- (10) Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares* - ------------------------------------------------------------------------------- (11) Percent of Class Represented by Amount in Row (9) 35.2% - ------------------------------------------------------------------------------- (12) Type of Reporting Person* IN - ------------------------------------------------------------------------------- *SEE INSTRUCTION BEFORE FILLING OUT! Item 1. (a) NAME OF ISSUER Canterbury Park Holding Corporation, a Minnesota corporation (b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES Canterbury Park Holding Corporation, 1100 Canterbury Drive, Shakopee, MN 55379. Item 2. (a) NAME OF PERSON FILING. This statement is being filed by Curtis A. Sampson, an individual. (b) ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE. The principal address of Mr. Sampson is 1100 Canterbury Drive, Shakopee, MN 55379. (c) CITIZENSHIP. Mr. Sampson is an American citizen. (d) TITLE OF CLASS OF SECURITIES. Common Stock, $0.01 par value per share. (e) CUSIP NUMBER. 13811E 10 1 Item 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 13d-1(b), OR 13d-2(b), CHECK WHETHER THE PERSON FILING IS A: Not applicable. Item 4. OWNERSHIP The following ownership of Mr. Sampson as of December 31, 1996 was as follows: (a) Amount Beneficially Owned 1,385,531 (b) Percent of Voting Shares Outstanding 35.2% (c) Number of shares as to which person has: (i) Sole power to vote or direct the vote: 1,385,531 (ii) Shared power to vote or direct the vote: 0 (iii) Sole power to dispose or direct the disposition of: 1,385,531 (iv) Shared power to dispose or direct the disposition of: 0 The shares listed above include 1,042,328 shares owned by Mr. Sampson directly and 343,203 shares issuable upon the exercise of currently issuable options and warrants. Item 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS Not Applicable. Page 3 of 4 --- --- 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 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. CERTIFICATES Not Applicable. SIGNATURES 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. February 14, 1997 /s/ Curtis A. Sampson ------------------------------ Curtis A. Sampson Page 4 of 4 --- --- -----END PRIVACY-ENHANCED MESSAGE-----