-----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, O5sKsVAJX2oK1MxlGIXyK3WpWiavKE63HL/e2lDvWcFpIKZkoFLdJLhIQC1XnT2/ EQPrpZfaOgij8seCPqhS1w== 0000890566-99-001574.txt : 19991216 0000890566-99-001574.hdr.sgml : 19991216 ACCESSION NUMBER: 0000890566-99-001574 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991213 FILED AS OF DATE: 19991215 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BILLSERV COM INC CENTRAL INDEX KEY: 0001088034 STANDARD INDUSTRIAL CLASSIFICATION: FUNCTIONS RELATED TO DEPOSITORY BANKING, NEC [6099] IRS NUMBER: 980190072 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-30152 FILM NUMBER: 99774550 BUSINESS ADDRESS: STREET 1: 14607 SAN PEDRO SUITE 100 CITY: SAN ANTONIO STATE: TX ZIP: 78232 BUSINESS PHONE: 2104025000 MAIL ADDRESS: STREET 1: 14607 SAN PEDRO SUITE 100 CITY: SAN ANTONIO STATE: TX ZIP: 78232 COMPANY DATA: COMPANY CONFORMED NAME: RONEY JACK M CENTRAL INDEX KEY: 0001070034 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER IRS NUMBER: 454808786 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 18 INWOOD RIDGE CITY: SAN ANTONIO STATE: TX ZIP: 78248 BUSINESS PHONE: 2104025000 MAIL ADDRESS: STREET 1: 18 INWOOD RIDGE CITY: SAN ANTONIO STATE: TX ZIP: 78248 3 1 FORM 3 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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 - ------------------------------------------------------------------------------------------------------------------------------------ |1. Name and Address of |2. Date of Event Re- |4. Issuer Name and Ticker or Trading Symbol | | Reporting Person | quiring Statment | | | | (Month/Day/Year) | | | RONEY JACK MICHAEL | 12/13/99 | billserv.com, Inc. -BLLS | | ---------------------------------- | ----------------- | ---------------------------------------------------------------- | | (Last) (First) (Middle) |3. IRS or Social Se- |5. Relationship of Reporting Person to Issuer |6. If Amendment, | | | curity Number of | (Check all applicable) | Date of Original | | | Reporting Person | | (Month/Day/Year) | | 14607 San Pedro Ave, Suite 100 | (Voluntary) | [ ] Director [ ] 10% Owner | | | ---------------------------------- | | | Filed | | (Street) | | |---------------------| | | | [X] Officer (give title [ ] Other (specify|7.Individual or Joint| | | ---------------- | below) below) | Group Filing (check| | San Antonio, Tx. 78232 | | | applicable line) | | ----------------------------------- | | ------------------------------------- | | | (City) (State) (Zip) | | |[X]Form filed by one | | | | VP - INVESTOR RELATIONS | reporting person | | | | |[ ]Form filed by more| | | | | than one reporting| | | | | person | | |------------------------------------------------------------------------------------------| | | | | | Table I -- Non-Derivative Securities Beneficially Owned | |---------------------------------------|------------------------------------------------------------------------------------------| |1. Title of Security |2. Amount of Securities | 3. Ownership | 4. Nature of Indirect Beneficial | | | Beneficially Owned | Form: Direct (D) | Ownership | | | (Instr. 4) | or Indirect (I) | (Instr. 5) | | | | (Instr. 5) | | |---------------------------------------|--------------------------------|----------------------|----------------------------------| | | | | | |---------------------------------------|--------------------------------|----------------------|----------------------------------| | | | | | |---------------------------------------|--------------------------------|----------------------|----------------------------------| | | | | | |---------------------------------------|--------------------------------|----------------------|----------------------------------| | | | | | |---------------------------------------|--------------------------------|----------------------|----------------------------------| | | | | | |---------------------------------------|--------------------------------|----------------------|----------------------------------| | | | | | |---------------------------------------|--------------------------------|----------------------|----------------------------------| | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) FORM 3 (Continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------------------------------------------------------------ |1. Title of Derivative |2. Date Exer- |3. Title and Amount of |4. Conver- |5. Ownership |6. Nature of In- | | Security (Instr. 4) | cisable and | Securities Underlying | sion or | Form of | direct Beneficial| | | Expiration | Derivative Security | Exercise| Derivative | Ownership | | | Date | (Instr. 4) | Price of| Security: | (Instr. 5) | | | (Month/Day/ | | Deri- | Direct (D) | | | | Year) | | vative | or Indirect| | | | | | Security| (I) | | | |-----------------|--------------------------------| | (Instr. 5) | | | | | | | Amount | | | | | |Date |Expira- | | or | | | | | |Exer- |tion | Title | Number | | | | | |cisable |Date | | of | | | | | | | | | Shares | | | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | Stock option | (1) |11/15/09| Common | 21,000 | $4.875 | D | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | | | | | | | | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | | | | | | | | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | | | | | | | | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | | | | | | | | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | | | | | | | | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | | | | | | | | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | | | | | | | | | |-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------| | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) 7,000 shares on 11/15/2000; 7,000 shares on 11/15/2001; 7,000 shares on 11/15/2002 /s/ JACK M. RONEY 12/13/1999 ------------------------------------------------------ ------------------- **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, See Instruction 6 for procedure.
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