-----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, KVBkdvVwVnTNb0mczS+4omfvoc2IlB3O+fA6hr1Ja49VzXv4mcQJRfmmxqo2yx68 e80TBV0u9V4UmUFwm9zPOA== 0000912057-01-006258.txt : 20010224 0000912057-01-006258.hdr.sgml : 20010224 ACCESSION NUMBER: 0000912057-01-006258 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20010220 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 SEC ACT: SEC FILE NUMBER: 005-43299 FILM NUMBER: 1550109 BUSINESS ADDRESS: STREET 1: 1100 CANTERBURY DR CITY: SHAKOPEE STATE: MN ZIP: 55379 BUSINESS PHONE: 6124457223 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: SAMPSON RANDALL D CENTRAL INDEX KEY: 0001042527 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 1100 CANTERBURY ROAD CITY: SHAKOPEE STATE: MN ZIP: 55379 BUSINESS PHONE: 9524457223 MAIL ADDRESS: STREET 1: 1100 CANTERBURY ROAD CITY: SHAKOPEE STATE: MN ZIP: 55379 SC 13G 1 a2039547zsc13g.txt 13G SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. )* Canterbury Park Holding Corporation ------------------------------------- (Name of Issuer) Common Stock, $.01 Par Value ------------------------------ (Title of Class of Securities) 13811E 10 1 ------------ (CUSIP Number) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: / / Rule 13d-1(b) /X/ Rule 13d-1(c) / / 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). (Continued on following page(s)) CUSIP NO. 13811E 10 1 13G PAGE 2 OF 5 PAGES - -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSON: Randall D. Sampson I.R.S. IDENTIFICATION NO. OF ABOVE PERSON: Not Applicable - -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS) (a) / / (b) /X/ - -------------------------------------------------------------------------------- 3 SEC USE ONLY - -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION Minnesota. - -------------------------------------------------------------------------------- 5 SOLE VOTING POWER NUMBER OF 227,466 SHARES ---------------------------------- BENEFICIALLY 6 SHARED VOTING POWER OWNED BY 2,000 EACH ---------------------------------- REPORTING 7 SOLE DISPOSITIVE POWER PERSON 227,466 WITH: ---------------------------------- 8 SHARED DISPOSITIVE POWER 2,000 - -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 229,466 - -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS) /X/ - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 6.6% - -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON (SEE INSTRUCTIONS) IN - -------------------------------------------------------------------------------- PAGE 3 OF 5 PAGES Item 1. (a) NAME OF ISSUER: Canterbury Park Holding Corporation (b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: 1100 Canterbury Road, Shakopee, MN 55379 ITEM 2. (a) NAME OF PERSON FILING. Randall D. Sampson (b) ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE. 1100 Canterbury Road, Shakopee, MN 55379 (c) CITIZENSHIP. Minnesota (d) TITLE OF CLASS OF SECURITIES. Common Stock (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 (a) / / Broker or Dealer registered under Section 15 of the Act (b) / / Bank as defined in Section 3(a)(6) of the Act (c) / / Insurance Company as defined in Section 3(a)(19) of the Act (d) / / Investment Company registered under Section 8 of the Investment Company Act (e) / / Investment Adviser registered under Section 203 of the Investment Advisers Act of 1940 (f) / / Employee Benefit Plan, Pension Fund which is subject to the provisions of the Employee Retirement Income Security Act of 1974 or Endowment Fund; Section 240.13d-1(b)(1)(ii)(F) (g) / / Parent Holding Company, in accordance with Section 240.13d-1(b)(ii)(G) (Note: See Item 7) (h) / / Group, in accordance with Section 240.13d-1(b)(ii)(H) PAGE 4 OF 5 PAGES ITEM 4. OWNERSHIP As of February 15, 2001, the beneficial ownership of shares of the Reporting Person was as follows: (a) Amount beneficially owned - Mr. Sampson beneficially owned 229,466 shares of the outstanding Common Stock of the Issuer. This number includes: (i) 101,466 shares of Common Stock (ii) options exercisable within 60 days of Febuary 15, 2001 to purchase 128,000 shares of Common Stock; and (iii) 2,000 shares of Common Stock owned by Ruckus Partnership, a Minnesota partnership, of which Mr. Sampson is a general partner. The aggregate amount beneficially owned by Mr. Sampson does not include, and Mr. Sampson disclaims beneficial ownership of, 3,000 shares of Common Stock owned by his children. (b) Percent of Class - 6.6%, assuming exercise of all options exercisable within 60 days of February 15, 2001. (c) Of the shares beneficially owned by the Reporting Person, it has the power to vote or dispose of the shares as follows: (i) Sole power to vote or direct the vote - 227,466 shares of Common Stock (including options) (ii) Shared power to vote or direct the vote - 2,000 (iii) Sole power to dispose or direct the disposition of - 227,466 shares of Common Stock (including options) (iv) Shared power to dispose or direct the disposition of - 2,000 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 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 PAGE 5 OF 5 PAGES Not Applicable ITEM 10. CERTIFICATION By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect. 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. /s/ Randall D. Sampson ---------------------------------- Randall D. Sampson Date: February 15, 2001 -----END PRIVACY-ENHANCED MESSAGE-----