-----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, UnNaid5GTpl2jrYj5cCydlZMTRBNkOjdLZSxK49MpDmdACOprm+7Malb4gAFrMWQ Sg6AVrW0FfAQ00Anslm4Pg== 0000927356-96-000924.txt : 19961017 0000927356-96-000924.hdr.sgml : 19961017 ACCESSION NUMBER: 0000927356-96-000924 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19961016 SROS: NASD SROS: PSE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BOARDWALK CASINO INC CENTRAL INDEX KEY: 0000915281 STANDARD INDUSTRIAL CLASSIFICATION: HOTELS & MOTELS [7011] IRS NUMBER: 880304201 STATE OF INCORPORATION: NV FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-44239 FILM NUMBER: 96643914 BUSINESS ADDRESS: STREET 1: 3750 LAS VEGAS BLVD SOUTH CITY: LAS VEGAS STATE: NV ZIP: 89109 BUSINESS PHONE: 7027352400 MAIL ADDRESS: STREET 1: 3750 LAS VEGAS BLVD SOUTH CITY: LAS VEGAS STATE: NV ZIP: 89109 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: JANSEN NORBERT W CENTRAL INDEX KEY: 0000938903 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 3750 LAS VEGAS BLVD SOUTH CITY: LAS VEGAS STATE: NV ZIP: 89109 MAIL ADDRESS: STREET 1: 3750 LAS VEGAS BLVD SOUTH CITY: LAS VEGAS STATE: NV ZIP: 89109 SC 13G 1 SCHEDULE 13-G FOR NORBERT JANSEN SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. 1)* BOARDWALK CASINO, INC. ---------------------- (Name of Issuer) $.001 PAR VALUE COMMON STOCK ---------------------------- (Title of Class of Securities) 096612 10 6 ----------- (CUSIP Number) Check the following box if a fee is being paid with this statement / /. (A fee is not required only if the filing person: (1) has a previous statement on file reporting beneficial ownership of more than five percent of the class of securities described in Item 1; and (2) has filed no amendment subsequent thereto reporting beneficial ownership of five percent or less of such class.) (See Rule 13d-7). *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 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 Pages CUSIP No. 096612 10 6 13G Page 2 of 4 Pages ----------- - -------------------------------------------------------------------------------- (1) Name of Reporting Person, S.S. or I.R.S. Identification Nos. of Above Person Norbert W. Jansen - -------------------------------------------------------------------------------- (2) Check the Appropriate Box if a Member of a Group* (a) / / (b) / / - -------------------------------------------------------------------------------- (3) SEC Use Only - -------------------------------------------------------------------------------- (4) Citizenship or Place of Organization USA - -------------------------------------------------------------------------------- Number of Shares Beneficially (5) Sole Voting Power 3,195,089 Owned by Each Reporting ----------------------------------------------- Person With (6) Shared Voting Power 15,000 ----------------------------------------------- (7) Sole Dispositive Power 3,195,089 ----------------------------------------------- (8) Shared Dispositive Power 15,000 - -------------------------------------------------------------------------------- (9) Aggregate Amount Beneficially Owned by Each Reporting Person 3,210,089 (please see notes 1 and 2) - -------------------------------------------------------------------------------- (10) Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares* - -------------------------------------------------------------------------------- (11) Percent of Class Represented by Amount in Row (9) 43.8 - -------------------------------------------------------------------------------- (12) Type of Reporting Person* IN - -------------------------------------------------------------------------------- *SEE INSTRUCTION BEFORE FILLING OUT! Page 3 of 4 Pages ITEM 1(a). NAME OF ISSUER: Boardwalk Casino, Inc. (b). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: 3750 Las Vegas Boulevard South Las Vegas, Nevada 89109 ITEM 2(a). NAME OF PERSON FILING: Norbert W. Jansen (b). ADDRESS OF PRINCIPAL BUSINESS OFFICE, OR IF NONE, RESIDENCE: 3750 Las Vegas Boulevard South Las Vegas, Nevada 89109 (c). CITIZENSHIP: U.S.A. (d). TITLE OF CLASS OF SECURITIES: Common Stock, $.001 par value (e). CUSIP NUMBER: 096612 10 6 ITEM 3. RULES 13D-1(B) OR 13D-2(B): Not applicable. ITEM 4. OWNERSHIP: (a) AMOUNT BENEFICIALLY OWNED: 3,210,089 shares (b) PERCENT OF CLASS: 43.8% (c) Norbert W. Jansen and Avis Jansen, Trustees U/A/D 07/14/93 (the "Trust") has sole power to vote and to dispose of 3,067,589 shares. Mr. Jansen is a co-trustee of the Trust. Mr. Jansen has sole power to vote and to dispose of an additional 127,500 shares and shares the power to vote and to dispose of 15,000 shares with his wife, Avis P. Jansen. 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 4 Pages 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. October 4, 1996 - ------------------------------------------------------------------------- Date /s/ NORBERT W. JANSEN - ------------------------------------------------------------------------- Signature Norbert W. Jansen - ----------------- Name/Title Note 1: Includes 142,500 shares of common stock that would result upon the exercise of vested options. Note 2: As computed under Rule 13(d) - 3(d)(1)(i). -----END PRIVACY-ENHANCED MESSAGE-----