UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G/A
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(AMENDMENT NO. THIRTEEN (13))
CPAC, Inc., 2364 Leicester Road, Leicester, New York 14481
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(Name of Issuer)
Common, Voting Stock ($.01 par value)
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(Title of Class of Securities)
126145101
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(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. 126145101 SCHEDULE 13G/A
1. Name of Reporting Person
S.S. or I.R.S. Identification No. of Above Person
THOMAS N. HENDRICKSON
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2. Check the Appropriate Box if a Member of a Group* N/A
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(a) [ ]
(b) [ ]
3. SEC use only
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4. Citizenship or Place of Organization UNITED STATES
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH:
5. Sole Voting Power 318,269.5
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6. Shared Voting Power 11,245
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7. Sole Dispositive Power 318,269.5
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8. Shared Dispositive Power 11,245
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9. Aggregate Amount Beneficially owned by Each Reporting Person 329,514.5
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10. Check Box if the Aggregate Amount in Row 9 Excludes Certain Shares*
[ ] (AGGREGATE IN ROW 9 EXCLUDES NO SHARES)
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11. Percent of Class Represented by Amount in Row 9 5.6%
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12. Type of Reporting Person* IN
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*SEE INSTRUCTION BEFORE FILLING OUT!
GENERAL INSTRUCTIONS
A. Statements containing the information required by this schedule shall be
filed not later than February 14 following the calendar year covered by the
statement or within the time specified in Rule 13d-1(b)(2), if applicable.
B. Information contained in a form which is required to be filed by rules under
section 13(f) (15 U.S.C. 78m(f)) for the same calendar year as that covered
by a statement on this schedule may be incorporated by reference in response
to any of the items of this schedule. If such information is incorporated
by reference in this schedule, copies of the relevant pages of such form
shall be filed as an exhibit to this schedule.
C. The item numbers and captions of the items shall be included but the text of
the items is to be omitted. The answers to the items shall be so prepared
as to indicate clearly the coverage of the items without referring to the
text of the items. Answer every item. If an item is inapplicable or the
answer is in the negative, so state.
ITEM 1.
(a) Name of Issuer CPAC, Inc.
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(b) Address of Issuer's Principal
Executive Offices 2364 Leicester Road
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Leicester, NY 14481
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ITEM 2.
(a) Name of Person Filing Thomas N. Hendrickson
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(b) Address of Principal Business Office or,
if none, Residence 2364 Leicester Road
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Leicester, NY 14481
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(c) Citizenship United States
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(d) Title of Class of Securities Common, voting stock
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($.01 par value)
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(e) CUSIP Number 126145101
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ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D-1(B), OR 13D-2(B), CHECK
WHETHER THE PERSON FILING IS A: N/A
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(a) [ ] Broker or Dealer registered under Section 15 of the Act
(b) [ ] Bank as defined in section 3(a)(6) of the Act
(c) [ ] Insurance Company as defined in section 3(a)(19) of this act
(d) [ ] Investment Company registered under section 8 of the Investment
Company Act
(e) [ ] Investment Adviser registered under section 203 of the Investment
Advisers Act of 1940
(f) [ ] Employee Benefit Plan, Pension Fund which is subject to the
provisions of the Employee Retirement Income Security Act of 1974
or Endowment Fund; see Rule 13d-1(b)(1)(ii)(F)
(g) [ ] Parent Holding Company, in accordance with Rule 13d-1(b)(ii)(G)
(Note: See Item 7)
(h) [ ] Group, in accordance with Rule 13d-1(b)(1)(ii)(H)
ITEM 4. OWNERSHIP
If the percent of the class owned, as of December 31 of the year covered by
the statement, or as of the last day of any month described in Rule 13d-1(b)(2),
if applicable, exceeds five percent, provide the following information as of
that date and identify those shares which there is a right to acquire.
(a) Amount Beneficially Owned 329,514.5 Shares*
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(b) Percent of Class 5.6%
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(c) Number of shares as to which such person has:
(i) sole power to vote or to direct the vote 318,269.5
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(ii) shared power to vote or to direct the vote 11,245
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(iii) sole power to dispose or to direct the disposition of 318,269.5
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(iv) shared power to dispose or to direct the disposition of 11,245
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* Amount listed in Item 4 (a) includes 11,245 shares owned by
Mr. Hendrickson's spouse; 14,766 shares of CPAC's Common Stock subject to
an option granted June 2, 1992; 9,375 shares of CPAC's Common Stock subject
to an option granted December 8, 1993; and 18,750 shares of CPAC's Common
Stock subject to an option granted February 9, 1994; which options are
exercisable within sixty (60) days of December 31, 1995.
Instruction: For computations regarding securities which represent a right
to acquire an underlying security see Rule 13d-3(d)(1).
ITEM 5.OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS N/A
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If this statement is being filed to report the fact that as of the date
hereof the reporting person has ceased to be the beneficial owner of more than
five percent of the class of securities, check the following [ ].
Instruction: Dissolution of a group requires a response to this item.
ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON N/A
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If any other person is known to have the right to receive or the power to
direct the receipt of dividends from, or the proceeds from the sale of, such
securities, a statement to that effect should be included in response to this
item and , if such interest relates to more than five percent of the class, such
person should be identified. A listing of the shareholders of an investment
company registered under the Investment Company Act of 1940 or the beneficiaries
of employee benefit plan, pension fund or endowment fund is not required.
ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE
SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY N/A
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If a parent holding company has filed this schedule, pursuant to Rule 13d-
1(b)(ii)(G), so indicate under Item 3(g) and attach an exhibit stating the
identity and the Item 3 classification of the relevant subsidiary. If a parent
holding company has filed this schedule pursuant to Rule 13d-1(c), attach an
exhibit stating the identification of the relevant subsidiary.
ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP N/A
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If a group has filed this schedule pursuant to Rule 13d-1(b)(ii)(H), so
indicate under Item 3(h) and attach an exhibit stating the identity and Item 3
classification of each member of the group. If a group has filed this schedule
pursuant to Rule 13d-1(c), attach an exhibit stating the identity of each member
of the group.
ITEM 9. NOTICE OF DISSOLUTION OF GROUP N/A
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Notice of dissolution of a group may be furnished as an exhibit stating the
date of the dissolution and that all further filings with respect to
transactions in the security reported on will be filed, if required, by members
of the group, in their individual capacity. See Item 5.
ITEM 10. CERTIFICATION
The following certification shall be included if the statement is filed
pursuant to Rule 13d-1(b):
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
purposes or 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.
January 23, 1996
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Date
/s/ Thomas N. Hendrickson
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THOMAS N. HENDRICKSON
President and Chief Executive Officer
