UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 5)*
Health Risk Management, Inc.
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(Name of Issuer)
Common Stock
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(Title of Class of Securities)
421935 10 7
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(CUSIP Number)
Check the following box if a fee is being paid with the statement . (A fee is
not required only if the reporting 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
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).
(Continued on following page(s))
Page 1 of 4 Pages
<PAGE>
SCHEDULE 13G
CUSIP No. 421935 10 7 Page 2 of 4 Pages
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1 NAME OF REPORTING PERSON
S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
Marlene O. Travis
###-##-####
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2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a)
(b)
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
U.S.A.
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NUMBER OF 5 SOLE VOTING POWER
SHARES
BENEFICIALLY 347,039 (includes 74,351 shares obtainable upon exercise
OWNED BY of currently exercisable options)
EACH ----------------------------------------------------------------
REPORTING 6 SHARED VOTING POWER
PERSON
WITH 0
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7 SOLE DISPOSITIVE POWER
347,039 (includes 74,351 shares obtainable upon exercise
of currently exercisable options)
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8 SHARED DISPOSITIVE POWER
0
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
347,039 (includes 74,351 shares obtainable upon exercise of currently
exercisable options)
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* X
Does not include 299,872 shares owned by reporting person's spouse or 75
shares owned by reporting person's adult children, as to all of which
reporting person disclaims beneficial ownership.
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
8.08%
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12 TYPE OF REPORTING PERSON*
IN
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*SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
Item 1(a) Name of Issuer:
Health Risk Management, Inc.
Item 1(b) Address of Issuer's Principal Executive Offices:
8000 West 78th Street
Minneapolis, MN 55439
Item 2(a) Name of Person Filing:
See Cover Page Item 1
Item 2(b) Address of Principal Business Office or, if none, residence:
8000 West 78th Street
Minneapolis, MN 55439
Item 2(c) Citizenship:
See Cover Page Item 4
Item 2(d) Title of Class of Securities:
Common Stock
Item 2(e) CUSIP No.:
See Cover Page
Item 3 Statement Filed Pursuant to Rules 13d-1(b) or 13d-2(b):
Not applicable
Item 4(a) Amount Beneficially Owned:
See Cover Page Item 9
Item 4(b) Percent of Class:
See Cover Page Item 11
Page 3 of 4 Pages
<PAGE>
Item 4(c) Number of Shares as to Which Such Person Has:
(i) sole power to vote or to direct the vote: See Cover Page Item 5
(ii) shared power to vote or to direct the vote: See Cover Page Item 6
(iii) sole power to dispose or direct the disposition of: See Cover Page
Item 7
(iv) shared power to dispose or direct the disposition of: See Cover
Page Item 8
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
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 as of December 31, 1996.
Dated: February 6, 1997
/s/ Marlene O. Travis
Marlene O. Travis
Page 4 of 4 Pages
