UNITED STATES

 

 

SECURITIES AND EXCHANGE COMMISSION

 

 

Washington, D.C. 20549

 

 

 

 

 

SCHEDULE 13G

 

 

Under the Securities Exchange Act of 1934
(Amendment No. 10)*

 

UFP Technologies, Inc.

(Name of Issuer)

 

Common Stock - $.01 Par Value

(Title of Class of Securities)

 

902673102

(CUSIP Number)

 

December 31, 2003

Date of Event which requires filing of this statement

 

Check the appropriate box to designate the rule pursuant to which this schedule is filed:

 

o

Rule 13d-1(b)

o

Rule 13d-1(c)

ý

Rule 13d-1(d)

 

*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 (the “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 5 Pages

 

 

CUSIP No.  902673102

Page 2 of 5 Pages

 

SCHEDULE 13G

Amendment No. 10

 

 

1)

Names of Reporting Persons; S.S. or I.R.S. Identification Nos. of Above Persons

               Richard L. Bailly

 

 

2)

Check the Appropriate Box if a Member of a Group (See Instructions)

 

 

 

 

 

(a)

 

 

 

 

 

 

 

(b)

 

 

 

3)

SEC Use Only

 

 

4)

Citizenship or Place of Organization U.S.A.

 

 

 

Number of Shares
Beneficially Owned
By Each Reporting
Person With

5)

Sole Voting Power

 

259,947

 

 

6)

Shared Voting Power

 

170,924

 

 

7)

Sole Dispositive Power

 

259,947

 

 

8)

Shared Dispositive Power

 

170,924

 

 

9)

Aggregate Amount Beneficially Owned by Each Reporting Person
                                 430,871

 

 

10)

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)  o

 

 

 

 

 

11)

Percent of Class Represented by Amount in Row (9)

 

9.5%

 

 

12)

Type of Reporting Person (See Instructions)

IN

 

 

CUSIP No.  902673102

Page 3 of 5 Pages

 

SECURITIES AND EXCHANGE COMMISSION

 

SCHEDULE 13G

 

AMENDMENT NO. 10

 

Item 1

(a)

Name of Issuer: UFP Technologies, Inc.

 

 

 

 

(b)

Address of Issuer’s Principal Executive Offices:

            172 East Main Street

            Georgetown, Massachusetts 01833

 

Item 2

(a)

Name of Person Filing:  Richard L. Bailly

 

 

 

 

(b)

Address of Principal Business Office or, if none, Residence:

              172 East Main Street

              Georgetown, Massachusetts 01833

 

 

 

 

(c)

Citizenship:  USA

 

 

 

 

(d)

Title of Class of Securities: Common Stock, $.01 par value

 

 

 

 

(e)

CUSIP NUMBER: 902673102

 

Item 3

If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:

 

 

Not Applicable

 

 

CUSIP No.  902673102

Page 4 of 5 Pages

 

Item 4

(a)

Amount Beneficially Owned:   

430,871

 

 

 

 

 

(b)

Percent of Class: 

9.5%

 

 

 

 

 

(c)

Number of Shares as to which such person has:

 

 

 

 

 

 

 

(i)

sole power to direct the vote   

259,947

 

 

 

 

 

 

 

(ii)

shared power to vote or to direct the vote  

170,924

 

 

 

 

 

 

 

(iii)

sole power to dispose or to direct the disposition of 

259,947

 

 

 

 

 

 

 

(iv)

shared power to dispose or to direct the disposition of 

170,924

 

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

 

 

 

(a) Not Applicable

 

 

 

(b) Not Applicable

 

 

CUSIP No.  902673102

Page 5 of 5 Pages

 

After reasonable inquiry and to the best of my knowledge and belief, I hereby certify that the information set forth in this statement is true, complete and correct.

 

 

February 13, 2004

 

Date

 


/s/ Richard L. Bailly

 

Signature

 


Richard L. Bailly

 

Name/Title