-----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, BXG+N2LtDR/R2GnL7QRfzziLRvPO6ouYYfPeYqi7tvBGgLENS4JG8yv4I4EJbRFh aqmYPviEY+7JDUhsbCUnfA== 0001144204-03-003460.txt : 20030701 0001144204-03-003460.hdr.sgml : 20030701 20030630181441 ACCESSION NUMBER: 0001144204-03-003460 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20030701 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: SINGHAL SHELLY CENTRAL INDEX KEY: 0001161595 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 754 EAST TECHNOLOGY AVENUE CITY: OREM STATE: UT ZIP: 84097 BUSINESS PHONE: 8012270004 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: QT 5 INC CENTRAL INDEX KEY: 0000932127 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-MEDICAL, DENTAL & HOSPITAL EQUIPMENT & SUPPLIES [5047] IRS NUMBER: 721148906 STATE OF INCORPORATION: DE FISCAL YEAR END: 0603 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-47022 FILM NUMBER: 03765867 BUSINESS ADDRESS: STREET 1: 5655 LINDERO CANYON ROAD STREET 2: SUITE 120 CITY: WESTLAKE VILLAGE STATE: CA ZIP: 91362 BUSINESS PHONE: (866) 508-8378 MAIL ADDRESS: STREET 1: 5655 LINDERO CANYON ROAD STREET 2: SUITE 120 CITY: WESTLAKE VILLAGE STATE: CA ZIP: 91362 FORMER COMPANY: FORMER CONFORMED NAME: MONEYZONE COM DATE OF NAME CHANGE: 20000120 FORMER COMPANY: FORMER CONFORMED NAME: EBONLINEINC COM DATE OF NAME CHANGE: 19990715 FORMER COMPANY: FORMER CONFORMED NAME: CERX VENTURE CORP DATE OF NAME CHANGE: 19981116 SC 13G 1 sc13g.txt UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. __________) * QT 5, INC. ---------- (Name of Issuer) COMMON STOCK (Title of Class of Securities) 747268100 --------- (CUSIP Number) May 22, 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: [ ] Rule 13d-1(b) [ ] Rule 13d-1(c) [X] 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 ("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).
- ---------------------------------------------- --------------------------------------------- CUSIP No. 747268100 13G Page 2 of 3 Pages - ---------------------------------------------- --------------------------------------------- - -------- ------------------------------------------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSON I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (entities only) Shelly Singhal - -------- ------------------------------------------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (See Instructions) (a) [ ] (b) [ ] Inapplicable - -------- ------------------------------------------------------------------------------------------------------------------- 3 SEC USE ONLY - -------- ------------------------------------------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States - ---------------------- ------ ---------------------------------------------------------------------------------------------- 5 SOLE VOTING POWER NUMBER OF SHARES 2,528,421 BENEFICIALLY OWNED BY ------ ---------------------------------------------------------------------------------------------- EACH REPORTING 6 SHARED VOTING POWER PERSON WITH 0 shares ------ ---------------------------------------------------------------------------------------------- 7 SOLE DISPOSITIVE POWER 2,528,421 ------ ---------------------------------------------------------------------------------------------- 8 SHARED DISPOSITIVE POWER 0 shares - -------- ------------------------------------------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 2,528,421 shares (1) - -------- ------------------------------------------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (See Instructions) - -------- ------------------------------------------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 7.54% - -------- ------------------------------------------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON (See Instructions) IN - -------- -------------------------------------------------------------------------------------------------------------------
Item 1. (a) Name of Issuer - QT 5, Inc. (b) Address of Issuer's Principal Executive Offices - 5655 Lindero Canyon Road, Suite 120, Westlake Village, California 91362 Item 2. (a) Names of Person Filing - Shelly Singhal (b) Address of Principal Business Office or, if none, Residence - SBI USA, a division of First Securities USA 2361 Campus Drive, Suite 210 Irvine, CA 92612 (c) Citizenship or Place of Organization - United States (d) Title of Class of Securities - Common Stock (e) CUSIP Number - 747268100 Item 3. (a) |_| Broker or Dealer registered under Section 15 of the Act (b) |_| Bank as defined in section 3(a)(6) of the Act (c) |_| Insurance Company as defined in section 3(a)(19) of the act (d) |_| Investment Company registered under section 8 of the Investment Company Act (e) |_| Investment Adviser registered under section 203 of the Investment Advisers Act of 1940 (f) |_| Employee Benefit Plan, Pension Fund which is subject to the provisions of the Employee Retirement Income Security Act of 1974 or Endowment Fund; see ss.240.13d-l(b)(l)(ii)(F) (g) |_| Parent Holding Company, in accordance with ss.240.13d-l(b)(ii)(G) (Note: See Item 7) (h) |_| Group, in accordance with ss.240.13d-l(b)(l)(ii)(J) Item 4. Ownership (a) Amount Beneficially Owned - Shelly Singhal has the sole power to vote or direct the vote and to dispose or direct the disposition of, and therefore beneficially own, 2,528,421 shares of common stock. (b) Percent of Class - The shares of common stock beneficially owned in the aggregate by Shelly Singhal represent approximately 7.54% of such class, which is based upon 33,537,426 shares of common stock outstanding as of May 22, 2003. (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote - Shelly Singhal has the sole power to vote or to direct the vote of 2,528,421 shares of common stock. (ii) shared power to vote or to direct the vote - Not applicable. (iii) sole power to dispose or to direct the disposition of - Shelly Singhal has the sole power to dispose or direct the disposition of 2,528,421 shares of common stock. (iv) shared power to dispose or to direct the disposition of - Not applicable. Item 5. Ownership of 5 Percent or Less of a Class If this Statement is being filed to report the fact that as of the date hereof the reporting person has chosen to be the beneficial owner of more than five percent of the class of security, check the following [X]. Item 6. Ownership of More than 5 Percent on Behalf of Another Person Inapplicable. Item 7. Identification and Classification of the Subsidiary Which Acquired the Securities 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 Group Inapplicable. Item 10. Certification Inapplicable. SIGNATURE After reasonable inquiry and to the best of our knowledge and belief, we certify that the information set forth in this statement is true, complete and correct. Date: June 23, 2003 Signature: /s/ Shelly Singhal ------------------------- Name: Shelly Singhal Attention: Intentional misstatements or omissions of fact constitute Federal criminal violations (See 18 U.S.C. 1001) -----END PRIVACY-ENHANCED MESSAGE-----