-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, EjajQ1rLF2h1J4O4/EVV546a1CEb2eKTLJWOr4rJRRXDyVIDLfQ2yNk7n8FVzej5 L/bPorVbo4gXRehXKBCkuQ== 0001301235-04-000015.txt : 20041103 0001301235-04-000015.hdr.sgml : 20041103 20041103153938 ACCESSION NUMBER: 0001301235-04-000015 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20041103 DATE AS OF CHANGE: 20041103 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SMARTSERV ONLINE INC CENTRAL INDEX KEY: 0001005698 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 133750708 STATE OF INCORPORATION: DE FISCAL YEAR END: 0902 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-49961 FILM NUMBER: 041116314 BUSINESS ADDRESS: STREET 1: METRO CENTER STREET 2: ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 BUSINESS PHONE: 2033535950 MAIL ADDRESS: STREET 1: ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: Headwaters Holdings, LLC CENTRAL INDEX KEY: 0001306652 IRS NUMBER: 943335860 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 30 LIBERTY SHIP WAY STREET 2: SUITE 3200 CITY: SAUSALITO STATE: CA ZIP: 94965 BUSINESS PHONE: 415-965-3555 MAIL ADDRESS: STREET 1: 30 LIBERTY SHIP WAY STREET 2: SUITE 3200 CITY: SAUSALITO STATE: CA ZIP: 94965 SC 13G 1 smartservdocument.txt SMARTSERV ONLINE, INC. UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No._)* SmartServ Online Inc - -------------------- (Name of Issuer) Common Stock, par value $.01 per share - --------------------------------------- (Title of Class of Securities) 83169M302 - --------- (CUSIP Number) October 8, 2004 - ------------- (Date of Event which Requires Filing of this statement) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: (x) Rule 13d-1(c) 1. Names of Reporting Person: Headwaters Holdings LLC 2. N/A 3. SEC Use Only 4. Citizenship or Place of Organization: California Number of shares Beneficially Owned by Each Reporting Person With: 5. Sole Voting Power: 545,754 shares 6. N/A 7. Sole Dispositive Power: 545,754 shares 8. N/A 9. Aggregate Amount Beneficially Owned by Each Reporting Person: 545,754 shares 10. N/A 11. Percent of Class Represented by Amount in Row (11): approx.18.48% 12. Type of Reporting Person: OO Item 1(a). Name of Issuer SmartServ Online, Inc. Item 1(b). Address of Issuer's Principal Executive Offices 2250 Butler Pike, Suite 150, Plymouth Meeting, PA. 19462 Item 2(a). Name of Person Filing: Headwaters Holdings, LLC. Item 2(b). Address of Principal Business Office: 30 Liberty Ship Way, Sausalito, California 94965 Item 2(c). Citizenship: Headwaters Holdings is a California Limited Liability Company Item 2(d). Title of Class of Securities Common Stock Item 2(e). Cusip Number 83169M302 Item 3. N/A Item 4. Ownership (a) 545,754 shares (b) 18.48% (c) (i) 545,754 shares (ii) N/A (iii) 545,754 shares (iv) N/A Item 5. N/A Item 6. N/A Item 7. N/A Item 8. N/A Item 9. N/A Item 10. Certification By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were acquired and are held in the ordinary course of business and were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose 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. November 3, 2004 - --------------- Date Headwaters Holdings, LLC /s/ Jeffrey D. Goshay - ------------------ Signature Jeffrey D. Goshay/Managing Member - -------------- Name/Title -----END PRIVACY-ENHANCED MESSAGE-----