-----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, WD+TA/RGyPhJlKVUlZpDb8qASjpVRY63e/iRILYNLmE/ZM0zZN6RLttgSDH5yXab FQEG1Ui0SSWeOIAGeg5xuQ== 0000927016-97-000464.txt : 19970222 0000927016-97-000464.hdr.sgml : 19970222 ACCESSION NUMBER: 0000927016-97-000464 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970214 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INNOVASIVE DEVICES INC CENTRAL INDEX KEY: 0001003608 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 043132641 STATE OF INCORPORATION: MA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-49257 FILM NUMBER: 97535691 BUSINESS ADDRESS: STREET 1: 734 FOREST ST CITY: MARLBOROUGH STATE: MA ZIP: 01752 BUSINESS PHONE: 5084346000 MAIL ADDRESS: STREET 1: 734 FOREST STREET CITY: MARLBOROUGH STATE: MA ZIP: 01752 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: NICHOLSON JAMES E CENTRAL INDEX KEY: 0001033646 STANDARD INDUSTRIAL CLASSIFICATION: [] STATE OF INCORPORATION: MA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 734 FOREST STREET CITY: MARLBOROUGH STATE: MA ZIP: 01752 MAIL ADDRESS: STREET 1: 14 MEADOW RD CITY: LINCOLN STATE: MA ZIP: 01773 SC 13G 1 SCHEDULE 13G OMB APPROVAL ----------------------------- OMB Number 3235-0145 Expires: October 31, 1997 Estimated average burden hours per response 14.90 ----------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G INFORMATION STATEMENT PURSUANT TO RULES 13D-1 AND 13D-2 UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. ______)* Innovasive Devices, Inc. - ------------------------------------------------------------------------------- (Name of Issuer) Common Stock, $.0001 par value - ------------------------------------------------------------------------------- (Title of Class of Securities) 45766K 10 4 ----------------------------------- (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 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 liabilites of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). CUSIP No. 45766K 10 4 13G Page 2 of 5 Pages =========================== ================= NAME OF REPORTING PERSON 1 S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON James E. Nicholson - ------------------------------------------------------------------------------ CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* 2 (a) [_] (b) [_] - ------------------------------------------------------------------------------ SEC USE ONLY 3 - ------------------------------------------------------------------------------ CITIZENSHIP OR PLACE OF ORGANIZATION 4 United States - ------------------------------------------------------------------------------ SOLE VOTING POWER 5 NUMBER OF 411,351 shares SHARES ----------------------------------------------------------- SHARED VOTING POWER BENEFICIALLY 6 0 OWNED BY ----------------------------------------------------------- EACH SOLE DISPOSITIVE POWER 7 REPORTING 411,351 PERSON ----------------------------------------------------------- SHARED DISPOSITIVE POWER WITH 8 0 - ------------------------------------------------------------------------------ AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 9 411,351 shares - ------------------------------------------------------------------------------ CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES 10 CERTAIN SHARES* [_] - ------------------------------------------------------------------------------ PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 11 5.7% - ------------------------------------------------------------------------------ TYPE OF REPORTING PERSON* 12 IN - ------------------------------------------------------------------------------ *SEE INSTRUCTIONS BEFORE FILLING OUT! Schedule 13G Page 3 of 5 Pages James E. Nicholson CUSIP Number 45766K 10 4 ITEM 1(A). NAME OF ISSUER. The issuer is Innovasive Devices, Inc. ("Innovasive"). ITEM 1(B). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES. The issuer's principal executive offices are located at 734 Forest Street, Marlborough, MA 07152-3032. ITEM 2(A). NAME OF PERSON FILING. The name of the person filing this statement is James E. Nicholson. ITEM 2(B). ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE. The business address of the person filing this statement is c/o Innovasive Devices, Inc., 734 Forest Street, Marlborough, MA 07152-3032. ITEM 2(C). CITIZENSHIP. James E. Nicholson is a citizen of the United States of America. ITEM 2(D). TITLE OF CLASS OF SECURITIES. The class of securities to which this statement relates is the Common Stock, $.0001 par value (the "Common Stock"), of Innovasive. ITEM 2(E). CUSIP NUMBER. The CUSIP number of the Common Stock is 45766K 10 4. ITEM 3. Not applicable. ITEM 4. OWNERSHIP. (A) AMOUNT BENEFICIALLY OWNED. James E. Nicholson is the beneficial owner of 411,351 shares of the Common Stock. Schedule 13G Page 4 of 5 Pages James E. Nicholson CUSIP Number 45766K 10 4 (B) PERCENT OF CLASS. The 411,351 shares of Common Stock beneficially owned by James E. Nicholson represent 5.7% of the outstanding shares of Common Stock as of December 31, 1996. (C) NUMBER OF SHARES AS TO WHICH SUCH PERSON HAS: (I) SOLE POWER TO VOTE OR TO DIRECT THE VOTE: James E. Nicholson has the sole power to vote or to direct the vote of 411,351 shares of Common Stock. (II) SHARED POWER TO VOTE OR TO DIRECT THE VOTE: James E. Nicholson has shared power to vote or to direct the vote of no shares of Common Stock. (III) SOLE POWER TO DISPOSE OR TO DIRECT THE DISPOSITION OF: James E. Nicholson has sole power to dispose or to direct the disposition of 411,351 shares of Common Stock. (IV) SHARED POWER TO DISPOSE OR TO DIRECT THE DISPOSITION OF: James E. Nicholson has shared power to dispose or to direct the disposition of no shares of Common Stock. 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. Schedule 13G Page 5 of 5 Pages James E. Nicholson CUSIP Number 45766K 10 4 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. 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/ James E. Nicholson - ------------------------- ----------------------------------- Date Signature James E. Nicholson -----END PRIVACY-ENHANCED MESSAGE-----