-----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, OrY5pS1EPot9dRoVQCu7Oazw+lWHdLCyUW0pR1tsDBPFOJ/uE9Uvh2+GkZXxsQTr qftTZyJ1erNvCACupHlbAg== 0001288845-04-000108.txt : 20040820 0001288845-04-000108.hdr.sgml : 20040820 20040820155251 ACCESSION NUMBER: 0001288845-04-000108 CONFORMED SUBMISSION TYPE: SC 13D/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040820 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: WAGNER JOSEPH CENTRAL INDEX KEY: 0001283545 FILING VALUES: FORM TYPE: SC 13D/A BUSINESS ADDRESS: STREET 1: 308 W ERIE STREET 2: 2ND FLOOR CITY: CHICAGO STATE: IL ZIP: 60610 BUSINESS PHONE: 3124044654 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: EXPERIENTIAL AGENCY INC CENTRAL INDEX KEY: 0001132034 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MANAGEMENT SERVICES [8741] IRS NUMBER: 880471263 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-79379 FILM NUMBER: 04989063 BUSINESS ADDRESS: STREET 1: JOHN HANCOCK CENTER STREET 2: 875 NORTH MICHIGAN AVENUE, SUITE 2626 CITY: CHICAGO STATE: IL ZIP: 60611 BUSINESS PHONE: 312-397-9100 MAIL ADDRESS: STREET 1: JOHN HANCOCK CENTER STREET 2: 875 NORTH MICHIGAN AVENUE, SUITE 2626 CITY: CHICAGO STATE: IL ZIP: 60611 FORMER COMPANY: FORMER CONFORMED NAME: SYNREAL SERVICES CORP DATE OF NAME CHANGE: 20010109 SC 13D/A 1 doc1.txt SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 SCHEDULE 13D/A (Amendment No. 2) UNDER THE SECURITIES EXCHANGE ACT OF 1934 THE EXPERIENTIAL AGENCY, INC. (NAME OF ISSUER) COMMON STOCK, PAR VALUE $0.001 PER SHARE (TITLE OF CLASS OF SECURITIES) 30215K 10 3 (CUSIP NUMBER) DAVID M. LOEV, ATTORNEY AT LAW 2777 ALLEN PARKWAY SUITE 1000 HOUSTON, TEXAS 77019 (713) 524-4110 (NAME, ADDRESS AND TELEPHONE NUMBER OF PERSON AUTHORIZED TO RECEIVE NOTICES AND COMMUNICATIONS) AUGUST 1, 2004 (DATE OF EVENT WHICH REQUIRES FILING OF THIS STATEMENT) IF THE FILING PERSON HAS PREVIOUSLY FILED A STATEMENT ON SCHEDULE 13G TO REPORT THE ACQUISITION WHICH IS THE SUBJECT OF THIS SCHEDULE 13D, AND IS FILING THIS SCHEDULE BECAUSE OF RULE 13D-1(B)(3) OR (4), CHECK THE FOLLOWING BOX. [ ] 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. |1| NAMES OF REPORTING PERSONS S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Joseph Wagner - --------------------------------------------------------------------------- |2| CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP * (a)[ ] (b)[ ] - -------------------------------------------------------------------------------- |3| SEC USE ONLY - -------------------------------------------------------------------------------- |4| SOURCE OF FUNDS* OO - -------------------------------------------------------------------------------- |5| CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e) [ ] - -------------------------------------------------------------------------------- |6| CITIZENSHIP OR PLACE OF ORGANIZATION United States - -------------------------------------------------------------------------------- |7| SOLE VOTING POWER NUMBER OF 18,588,796 SHARES -------------------------------------------------------------- BENEFICIALLY |8| SHARED VOTING POWER OWNED BY EACH N/A REPORTING -------------------------------------------------------------- PERSON WITH |9| SOLE DISPOSITIVE POWER 7,704,002 - -------------------------------------------------------------------------------- |10| SHARED DISPOSITIVE POWER N/A - -------------------------------------------------------------------------------- |11| AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 18,588,796 - -------------------------------------------------------------------------------- |12| CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES * N/A - -------------------------------------------------------------------------------- |13| PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 28.6% - -------------------------------------------------------------------------------- |14| TYPE OF REPORTING PERSON * IN - -------------------------------------------------------------------------------- ITEM 1. Security and Issuer This amended Statement on Schedule 13D relates to the Common Stock of The Experiential Agency, Inc. The principal executive offices of The Experiential Agency, Inc. are located at 875 North Michigan Avenue, Suite 2626, Chicago, IL 60611. ITEM 2. Identity and Background (a)-(c) This amended Statement on Schedule 13D is being filed by Joseph Wagner. Mr. Wagner's business address is 875 North Michigan Avenue, Suite 2626, Chicago, IL 60611. Mr. Wagner is the President, Chief Operating Officer and Secretary of The Experiential Agency, Inc. (d)-(e) During the last five years, Mr. Wagner: (i) has not been convicted in a criminal proceeding (excluding traffic violations or similar misdemeanors); or (ii) was not a party to a civil proceeding of a judicial or administrative body of competent jurisdiction and as a result of such proceeding was or is subject to a judgment, decree or final order enjoining future violations of, or prohibiting or mandating activities subject to, federal or state securities laws or finding any violation with respect to such laws. (f) Mr. Wagner is a citizen of the United States. ITEM 3. Source of Amount of Funds or Other Compensation On August 1, 2004, the Registrant granted 4,500,000 shares of Common Stock subject to a risk of forfeiture to Joseph Wagner as additional consideration for entering into a consulting agreement with the Registrant. Mr. Wagner instructed that the shares be issued in his spouse's name, Sandra M. Wagner. If Mr. Wagner's consulting agreement terminates before December 31, 2004, December 31, 2005 or December 31, 2006, he must return to the Registrant 4,500,000 shares, 3,000,000 shares or 1,500,000 shares, respectively, of Common Stock. ITEM 4. Purpose of Transaction Mr. Wagner acquired the securities of The Experiential Agency, Inc. for investment purposes. Depending on general market and economic conditions affecting The Experiential Agency, Inc. and other relevant factors, Mr. Wagner may purchase additional securities of The Experiential Agency, Inc. or dispose of some or all of securities from time to time in open market transactions, private transactions or otherwise. Mr. Wagner does not have any plans or proposals which relate to or result in: (a) the acquisition by any person of additional securities of The Experiential Agency, Inc., or the disposition of securities of The Experiential Agency, Inc.; (b) an extraordinary transaction, such as a merger, reorganization or liquidation, involving The Experiential Agency, Inc. or any of its subsidiaries; (c) a sale or transfer of a material amount of assets of The Experiential Agency, Inc. or any of its subsidiaries; (d) any change in the present board of directors or management of The Experiential Agency, Inc., including any plans or proposals to change the number or term of directors or to fill any existing vacancies on the board; (e) any material change in the present capitalization or dividend policy of The Experiential Agency, Inc.; (f) any other material changes in The Experiential Agency, Inc.'s business or corporate structure; (g) changes in The Experiential Agency, Inc.'s charter, bylaws or instruments corresponding thereto or other actions which may impede the acquisition of control of The Experiential Agency, Inc. by any person; (h) causing a class of securities of The Experiential Agency, Inc. to be delisted from a national securities exchange or cease to be authorized to be quoted in an inter-dealer quotation system of a registered national securities association; (i) a class of equity securities of The Experiential Agency, Inc. becoming eligible for termination of registration pursuant to Section 12(g)(4) of the Securities Exchange Act of 1934; or (j) any action similar to any of those enumerated above. ITEM 5. Interest in Securities of the Issuer (a) Joseph Wagner beneficially owns 18,588,796 shares of Common Stock of The Experiential Agency, Inc. which includes 704,002 shares owned directly by Mr. Wagner, 7,000,000 shares owned by Mr. Wagner's wife, Sandra M. Wagner, and voting rights to 10,884,794 shares of Common Stock directly owned by Frank Goldstin. The shares of Common Stock beneficially owned by Mr. Wagner constitute approximately 28.6% of the total number of shares of Common Stock of The Experiential Agency, Inc., based upon 64,894,391 shares of Common Stock outstanding as of August 13, 2004. (b) Mr. Wagner has the sole power to vote or to direct the vote of all the shares beneficially owned by Mr. Wagner, and the sole power to dispose or to direct the disposition of 7,704,002 of the shares beneficially owned by Mr. Wagner which includes 704,002 shares owned directly by Mr. Wagner and 7,000,000 shares owned by Mr. Wagner's wife, Sandra M. Wagner. (c) Mr. Wagner acquired Common Stock as a result of the transaction discussed in ITEM 3, above. (d) Frank Goldstin has the right to receive or the power to direct the receipt of dividends from or the proceeds from the sale of the 10,884,794 shares of Common Stock which Mr. Wagner has the right to vote. (e) Not applicable. ITEM 6. Contracts, Arrangements, Understanding or Relationships with Respect to Securities of the Issuer Joseph Wagner has a Voting Agreement in place with Frank Goldstin, whereby Mr. Wagner has the right to vote 10,884,794 shares of Mr. Goldstin's Common Stock. ITEM 7. Material to be Filed as Exhibits Exhibit 1(1) Voting Agreement dated July 26, 2004, between Joseph Wagner and Frank Goldstin. Exhibit 2(2) Consulting Agreement with Joseph Wagner. (1) Filed as Exhibit 10.1 to our Form 8-K filed on August 6, 2004. (2) Filed as Exhibit 10.6 to our Form SB-2 filed on August 17, 2004. 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. Dated: August 20, 2004 By: /s/ Joseph Wagner --------------------- Joseph Wagner -----END PRIVACY-ENHANCED MESSAGE-----