UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 2)*
OXBORO MEDICAL INTERNATIONAL, INC.
(Name of Issuer)
COMMON STOCK, PAR VALUE $0.01 PER SHARE
(Title of Class of Securities)
691384 10 1
(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 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).
CUSIP No. 691384 10 1 13G
1. NAME OF REPORTING PERSON
SS OR IRS IDENTIFICATION NO. OF ABOVE PERSON
Harley Haase
###-##-####
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* N/A
(a) [ ]
(b) [ ]
3. SEC USE ONLY
4. CITIZENSHIP OR PLACE OF ORGANIZATION
United States of America
NUMBER 5. SOLE VOTING POWER 211,062
OF SHARES
BENEFICIALLY 6. SHARED VOTING POWER 25,686 (held in ESOP)
OWNED BY EACH
REPORTING 7. SOLE DISPOSITIVE POWER 211,062
PERSON WITH
8. SHARED DISPOSITIVE POWER 25,686 (held in ESOP)
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
236,748
10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
[ ] N/A
11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
8.8%
12. TYPE OF REPORTING PERSON*
Individual (IN)
*SEE INSTRUCTIONS BEFORE FILLING OUT!
AMENDMENT NO. 2 TO SCHEDULE 13G
ITEM 1. NAME AND ADDRESS OF ISSUER
Oxboro Medical International, Inc.
13828 Lincoln Street N.E.
Ham Lake, Minnesota 55304
ITEM 2. NAME AND ADDRESS OF PERSON FILING:
a. Harley Haase
b. 13828 Lincoln Street N.E.
Ham Lake, Minnesota 55304
c. United States of America
d. Common Stock, Par Value $0.01 Per Share
e. 691384 10 1
ITEM 3. RULE 13-3(b), OR 13d-2(b):
Not Applicable
ITEM 4. OWNERSHIP
a. Amount Beneficially Owned: 236,748
b. Percent of Class: 8.8%
c. Number of shares as to which such person has:
(i) sole power to vote or direct the vote 211,062
(ii) shared power to vote or to direct the vote 25,686*
(iii) sole power to dispose or to direct the disposition
of 211,062
(iv) shared power to dispose or to direct the disposition
of 25,686*
* held in ESOP
ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF 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
By signing below, I certify that to the best of my knowledge and
belief, the securities referred to above were acquired in the ordinary course of
business and were not acquired for the purpose of and do not have the effect of
changing or influencing the control of the issuer of such securities and were
not acquired in connection with or as a participant in any transaction having
such purpose of 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.
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Date
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Signature
Harley Haase, President
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Name/Title
