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THIS DOCUMENT IS A COPY OF THE SCHEDULE 13G FILED ON FEBRUARY 18, 1997 PURSUANT
TO A RULE 201 TEMPORARY HARDSHIP EXEMPTION.
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
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SCHEDULE 13G
INFORMATION STATEMENT PURSUANT TO RULES 13d-1 AND 13d-2
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(AMENDMENT NO. ____)
NCS HEALTHCARE, INC.
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(Name of Issuer)
CLASS A COMMON STOCK, $.01 PAR VALUE
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(Title of Class of Securities)
628874 10 9
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(CUSIP Number)
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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 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).
Page 1 of 6
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CUSIP NO. 628874 10 9 13G PAGE 2 OF 6 PAGES
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<TABLE>
<CAPTION>
<S> <C>
- --------- ------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS
Kevin B. Shaw
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2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
Not Applicable
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
United States
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NUMBER OF 5 SOLE VOTING POWER
SHARES
BENEFICIALLY 1,144,667
OWNED ----------- ---------------------------------------------------------------
BY EACH 6 SHARED VOTING POWER
REPORTING
PERSON 7,130
WITH: ----------- ---------------------------------------------------------------
7 SOLE DISPOSITIVE POWER
1,144,667
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8 SHARED DISPOSITIVE POWER
7,130
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON
1,151,797
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES
CERTAIN SHARES [ ]
Not Applicable
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
9.9%
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12 TYPE OF REPORTING PERSON*
IN
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</TABLE>
* SEE INSTRUCTIONS BEFORE FILLING OUT!
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NCS HEALTHCARE, INC.
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Schedule 13G of Kevin B. Shaw
ITEM 1(a). NAME OF ISSUER:
NCS HealthCare, Inc.
ITEM 1(b). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES:
3201 Enterprise Parkway, Suite 220, Beachwood, Ohio 44122
ITEM 2(a). NAME OF PERSON FILING:
Kevin B. Shaw
ITEM 2(b). ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE:
3201 Enterprise Parkway, Suite 220, Beachwood, Ohio 44122
ITEM 2(c). CITIZENSHIP:
United States
ITEM 2(d). TITLE OF CLASS OF SECURITIES:
Class A Common Stock, $.01 par value
ITEM 2(e). CUSIP NUMBER:
628874 10 9
ITEM 3.
Not Applicable
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ITEM 4. OWNERSHIP.
(a) Amount beneficially owned:
1,151,797 shares of Class A Common Stock (1)(2)(3)
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(b) Percent of class:
9.9%(3)
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(c) Number of shares as to which such person has:
(i) Sole power to vote or to direct the vote 1,144,667(1)
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(ii) Shared power to vote or to direct the vote 7,130(2)
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(iii) Sole power to dispose or to direct the disposition of
1,144,667(1)
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(iv) Shared power to dispose or to direct the disposition of
7,130(2)
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(1) Includes (a) 956,764 shares of Class B Common Stock, $.01 par value
("Class B Common Stock"), (b) 184,370 shares of Class B Common Stock
held by a limited partnership of which the reporting person is sole
general partner and (c) 3,333 shares of Class A Common Stock underlying
options. Each share of Class B Common Stock is convertible at any time
into one share of Class A Common Stock.
(2) 7,130 shares of Class A Common Stock Owned as of record by the
reporting person's wife.
(3) Assumes conversion of all shares of Class B Common Stock held by
reporting person into shares of Class A 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
ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP.
Not Applicable
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ITEM 9. NOTICE OF DISSOLUTION OF GROUP.
Not Applicable
ITEM 10. CERTIFICATION.
Not Applicable
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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.
FEBRUARY 14, 1997
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Date
/s/ Kevin B. Shaw
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Signature
Kevin B. Shaw
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Name
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