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OMB APPROVAL
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OMB Number 3235-0145
Expires: October 31, 1997
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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.
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(Name of Issuer)
Common Stock, $.0001 par value
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(Title of Class of Securities)
45766K 10 4
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(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).
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CUSIP No. 45766K 10 4 13G Page 2 of 5 Pages
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NAME OF REPORTING PERSON
1 S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
James E. Nicholson
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
2 (a) [_]
(b) [_]
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SEC USE ONLY
3
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CITIZENSHIP OR PLACE OF ORGANIZATION
4
United States
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SOLE VOTING POWER
5
NUMBER OF 411,351 shares
SHARES -----------------------------------------------------------
SHARED VOTING POWER
BENEFICIALLY 6
0
OWNED BY
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EACH SOLE DISPOSITIVE POWER
7
REPORTING 411,351
PERSON -----------------------------------------------------------
SHARED DISPOSITIVE POWER
WITH 8
0
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
9
411,351 shares
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES
10 CERTAIN SHARES* [_]
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
11
5.7%
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TYPE OF REPORTING PERSON*
12
IN
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*SEE INSTRUCTIONS BEFORE FILLING OUT!
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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.
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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.
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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
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Date Signature
James E. Nicholson
