-----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, PMHGkYetpxAZVWnV2fzlWG0oGft9Hhkb1wAoXoOKGRWk9i7uOibCFrEGZ91xGElr xuzIja8PnZauj1Gj5Qa9nw== 0000950134-99-011012.txt : 19991215 0000950134-99-011012.hdr.sgml : 19991215 ACCESSION NUMBER: 0000950134-99-011012 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991130 FILED AS OF DATE: 19991214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MSI HOLDINGS INC/ CENTRAL INDEX KEY: 0000068619 STANDARD INDUSTRIAL CLASSIFICATION: COMPUTER & OFFICE EQUIPMENT [3570] IRS NUMBER: 870280886 STATE OF INCORPORATION: UT FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-08164 FILM NUMBER: 99773874 BUSINESS ADDRESS: STREET 1: 501 WALLER ST. STREET 2: SUITE 400 CITY: AUSTIN STATE: TX ZIP: 78702 BUSINESS PHONE: 5124766925 MAIL ADDRESS: STREET 1: 501 WALLER STREET 2: SUITE 400 CITY: AUSTIN STATE: TX ZIP: 78702 FORMER COMPANY: FORMER CONFORMED NAME: MICRO MEDIA SOLUTIONS INC DATE OF NAME CHANGE: 19970724 FORMER COMPANY: FORMER CONFORMED NAME: MOUNTAIN STATES RESOURCES CORP DATE OF NAME CHANGE: 19960805 COMPANY DATA: COMPANY CONFORMED NAME: ENTREPRENEURIAL INVESTORS LTD CENTRAL INDEX KEY: 0001077515 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER IRS NUMBER: 000000000 STATE OF INCORPORATION: C5 FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: CITIBANK BUILDING, SECOND FLOOR STREET 2: EAST MALL DR., P.O. BOX 40843 CITY: FREEPORT BAHAMAS BUSINESS PHONE: 2149994258 MAIL ADDRESS: STREET 1: CITIBANK BUILDING, SECOND FLOOR STREET 2: EAST MALL DR., P.O. BOX 40843 CITY: FREEPORT BAHAMAS 4 1 FORM 4 - ENTREPRENEURAL INVESTORS, LTD. 1 - ------ -------------------------- FORM 4 OMB APPROVAL - ------ -------------------------- [ ] CHECK THIS BOX IF NO OMB Number: 3235-0287 LONGER SUBJECT TO Expires: December 31, 2001 SECTION 16. FORM 4 Estimated average burden OR FORM 5 OBLIGATIONS hours per response.... 0.5 MAY CONTINUE. SEE -------------------------- INSTRUCTION 1(b). UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 (Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) Entrepreneurial Investors, Ltd. MSI Holdings, Inc. (MSIA) to Issuer (Check all applicable) - --------------------------------------------- ---------------------------------------------- Director X 10% Owner (Last) (First) (Middle) 3. IRS Identification 4. Statement for ---- --- Number of Reporting Month/Year Officer (give Other (Specify Citibank Building, Second floor, East Mall Dr. Person, if an entity November 1999 ---- title --- below) - --------------------------------------------- (voluntary) ------------------- below) (Street) 5. If Amendment, Freeport, G.B., Bahamas Date of Original - --------------------------------------------- -------------------- (Month/Year) -------------------------------- (City) (State) (Zip) 7. Individual or Joint/Group Filing ------------- (Check Applicable Line) X Form filed by One Reporting --- Person Form filed by More than One --- Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature (Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In- Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct (Instr. 8) End of Month Direct Benefi- (Month/ (Instr. 3 and 4) (D) or cial Day/ ------------------------------------ Indirect Owner- Year) Code V Amount (A) or Price (I) ship (D) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) * If the form is filed by more than one reporting person, see Instruction 4(b)(v). SEC 1474 (3-99) POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTIONS OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER.
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FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv- Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative Deriv- Day/ Disposed of (D) (Month/Day/ Secur- ative Year) (Instr. 3, 4, Year) ity Security and 5) (Instr. 5) ----------------------------------- Date Expira- Amount or -------------------------- Exer- tion Title Number of Code V (A) (D) cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock Option (Right to Buy) $1.50 11/3/99 S 2,400,000 1/3/98 1/31/00 Stock 2,400,000 $2.50 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 9. Number of 10. Ownership 11. Nature of Derivative Form of Indirect Securities Derivative Beneficial Beneficially Security: Ownership Owned at End Direct (D) (Instr. 4) of Month or Indirect (I) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------- -0-(1) N/A - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) Excludes other derivative securities with different vesting dates and exercise prices. ENTREPRENEURIAL INVESTORS, LTD. By: /s/ Robert E. Cordes 12/9/99 **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. ------------------------------- ------- See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Robert E. Cordes, President Date **Signature of Reporting Person Note: File three copies of this Form, one of which must be manually signed. Page 2 If space is insufficient, see Instruction 6 for procedure. SEC 1474 (3-99) Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
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