-----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, G6PZHYt8qktZeZAus0Yfadrl1dZ+XjbNLcoe7mEoji/KmogPfMeGw/28q9ajTO3A 7mji1L8NePndWw2U5tq2VQ== 0001133884-02-000114.txt : 20020414 0001133884-02-000114.hdr.sgml : 20020414 ACCESSION NUMBER: 0001133884-02-000114 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020131 FILED AS OF DATE: 20020212 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BILLSERV 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: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-30152 FILM NUMBER: 02536452 BUSINESS ADDRESS: STREET 1: 211 N LOOP 1604 STREET 2: SUITE 100 CITY: SAN ANTONIO STATE: TX ZIP: 78232 BUSINESS PHONE: 2104025000 MAIL ADDRESS: STREET 1: 211 N LOOP 1604 STREET 2: STE 100 CITY: SAN ANTONIO STATE: TX ZIP: 78232 FORMER COMPANY: FORMER CONFORMED NAME: BILLSERV COM INC DATE OF NAME CHANGE: 19990607 COMPANY DATA: COMPANY CONFORMED NAME: BINDSEIL MARK CENTRAL INDEX KEY: 0001140840 OFFICER STATE OF INCORPORATION: NV FILING VALUES: FORM TYPE: 4/A BUSINESS ADDRESS: STREET 1: 211 N. LOOP 1604 E. SUITE 100 CITY: SAN ANTONIO STATE: TX ZIP: 78232 4/A 1 gform4a-27149b.txt FORM 4/A UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB Approval FORM 4/A WASHINGTON, D.C. 20549 ------------------ |_| Check this box if no OMB Number 3235-0287 longer subject to Expires: December 31, 2001 Section 16. Form 4/A STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden or Form 5 Hours per response....0.5 obligations may continue Instruction 1(b). 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) to Issuer (Check all applicable) Bindseil Mark Billserv, Inc. BLLS Director 10% Owner - -------------------------------------------- ----------------------------------------------- --- --- (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for X Officer (give Other (specify Number of Reporting Month/Year --- title below) --- below) Person (Voluntary) JANUARY 2002 VP, Controller 211 North Loop 1604 East, Suite 100 ------------------------------------- - -------------------------------------------- ------------------- --------------------------------------- (Street) 5. If Amendment, 7. Individual or Joint/Group Filing Date of Original (Check Applicable Line) (Month/Year) X Form filed by One Reporting Person --- Form filed by More than One San Antonio Texas 78232 N/A ---Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ---------------------------------------------------------------------------------------------------------------------------------- 1.Title of Security 2.Trans- 3.Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7.Nature of (Instr. 3) action action or Disposed of (D) Securities ship Indirect Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial (Instr. 8) Owned at Direct Owner- End of Month (D) or ship (Month/ ------------------------------------- (Instr. 3 and Indirect (Instr. 4) Day/ Code V Amount (A)or Price 4) (I) Year) (D) (Instr.4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1/8/02 P(1) 3,852 A .92 3,852 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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 (7-96)
FORM 4/A (CONTINUED) TABLE II-- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - -------------- ---------- --------- --------- ------------- ------------- ------------ -------- --------- ---------- ------------- 1.Title of 2.Conver- 3.Trans- 4.Trans- 5.Number of 6.Date Exer- 7.Title and 8.Price 9.Number 10.Owner- 11.Nature Derivative sion action action Derivative cisable and Amount of of of ship of Security or Date Code Securities Expiration Underlying Deriv- Deriv- Form Indirect Instr. 3) Exercise (Instr. Acquired Date Securities Ative ative of Beneficial Price of (Month/ 8) (A)or (Month/Day/ (Instr. 3 Secur- Secur- Deriv- Ownership Deri- Day/ Disposed of Year) and 4) ity ities ative (Instr.4) vative Year) (D)(Instr. (Instr Bene- Security: Security 3, 4 and 5) 5) ficially Direct Owned (D) or ----- --- ----- ----- ------- ------- ----- ------- at End Indirect Code V (A) (D) Date Expira- Title Amount of (I) Exer- tion or Month (Instr. cisable Date Number (Instr. 4) of 4) Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: - ----------------------------------------- (1) ESPP purchase - ----------------------------------------- /s/ Mark Bindseil 2/10/2002 **Intentional misstatements or omissions of facts constitute ----------------------------- ------------------ Federal Criminal Violations. **Signature of Reporting Person Date 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 is insufficient, SEE Instruction 6 for procedure. 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. Page 2 SEC 1474 (7-96)
-----END PRIVACY-ENHANCED MESSAGE-----