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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(AMENDMENT NO. X )*
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ARTERIAL VASCULAR ENGINEERING, INC.
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(Name of Issuer)
COMMON STOCK
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(Title of Class of Securities)
043013-10-1
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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).
Page 1 of 4 Pages
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CUSIP NO. 043013-10-1 13G PAGE 2 OF 4 PAGES
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NAME OF REPORTING PERSON
1 S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
Putra Masagung; Social Security No. ###-##-####
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
2 (a) [_]
N/A (b) [_]
- ------------------------------------------------------------------------------
SEC USE ONLY
3
- ------------------------------------------------------------------------------
CITIZENSHIP OR PLACE OF ORGANIZATION
4
Indonesia
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SOLE VOTING POWER
5
NUMBER OF 4,394,471 shares of Common Stock
SHARES -----------------------------------------------------------
SHARED VOTING POWER
BENEFICIALLY 6
0
OWNED BY
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EACH SOLE DISPOSITIVE POWER
7
REPORTING 4,394,471 shares of Common Stock
PERSON -----------------------------------------------------------
SHARED DISPOSITIVE POWER
WITH 8
0
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
9
4,394,471 shares of Common Stock
- ------------------------------------------------------------------------------
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
10
N/A
- ------------------------------------------------------------------------------
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
11
14.19%
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TYPE OF REPORTING PERSON*
12
IN
- ------------------------------------------------------------------------------
*SEE INSTRUCTION BEFORE FILLING OUT!
Page 2 of 8 pages
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Page 3 of 4 pages
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
Schedule 13G
Under the Securities Exchange Act of 1934
Fee enclosed [_] or Amendment No. 3
Item 1(a) Name of Issuer:
ARTERIAL VASCULAR ENGINEERING, INC.
Item 1(b) Address of Issuer's Principal Executive Offices:
3576 Unocal Place, Santa Rosa, CA 94503
Item 2(a) Name of Person(s) Filing:
Putra Masagung
Item 2(b) Address of Principal Business Office:
3235 Ralston Avenue
Hillsborough CA 94010
Item 2(c) Citizenship: Indonesia
Item 2(d) Title of Class of Securities:
Common Stock of Arterial Vascular Engineering, Inc.
Item 2(e) CUSIP Number: 043013-10-1
Item 3 The person(s) filing is(are):
Inapplicable
Item 4 Ownership
(a) As of December 31, 1996, Mr. Masagung beneficially owned 4,394,471
shares of Common Stock. Mr. Masagung is the beneficial owner of such shares
by virtue of his being the sole equity owner of the outstanding stock of
Radstock Enterprises Limited, a company organized under the laws of the
British Virgin Islands.
(b) The shares beneficially owned by Mr. Masagung represent 14.19% of
the outstanding Common Stock of the Issuer.
(c) Number of shares as to which such person has:
i) The number of shares of Common Stock which Mr. Masagung has
the sole power to vote or to direct the vote of is 4,394,471.
ii) The number of shares of Common Stock which Mr. Masagung has
shared power to vote or to direct the vote of is 0.
iii) The number of shares of Common Stock which Mr. Masagung has
the sole power to dispose of or to direct the disposition of is 4,394,471.
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Page 4 of 4 pages
iv) The number of shares of Common Stock which Mr. Masagung has
shared power to dispose of or to direct the disposition of is 0.
Mr. Masagung does not currently possess any rights to acquire additional shares
of the Issuer's Common Stock.
Item 5. Ownership of Five Percent or Less of a Class
Inapplicable.
Item 6. Ownership of More than 5% on Behalf of Another Person:
Inapplicable.
Item 7. Identification and Classification of the Subsidiary Which Acquired the
Security Being Reported on By the Parent Holding Company
Inapplicable.
Item 8. Identification and Classification of Members of the Group
Inapplicable.
Item 9. Notice of Dissolution of the Group
Inapplicable.
Item 10. Certification
Inapplicable.
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.
Date: February 3, 1997
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Signature: /s/ Putra Masagung
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Name/Title: Putra Masagung
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