5 1 form5berniew.htm ISA INTERNATIONALE, INC. FORM 5 Form 5

Form 5

__  Check box if no longer subject to 
      Section 16. Form 4 or Form 5 obligations
      may continue. See Instruction 1(b).

__ Form 3 Holdings Reported

_X_ Form 4 Transactions Reported

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549


ANNUAL STATEMENT OF CHANGES 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

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1.  Name and Address of Reporting Person*

Brodkorb, Bernard L.

2.  Issuer Name and Tickler or Trading Symbol

 ISA Internationale, Inc. (ISAI)

6. Relationship of Reporting Person(s) to Issuer
                           (Check all applicable)

_X_ Director                                  _X__ 10% Owner
_X__ Officer (give title below)        ___ Other (specify below)
 

(Last)         (First)        (Middle)

224 No. Owasso Blvd.

3.  I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)

 

4.  Statement for   Month/Year

 July 2002

(Street)

Shoreview, MN 55126

5.  If Amendment, Date of Original
   (Month/Year)

 

7.  Individual or Joint/Group Reporting
            (check applicable line)
_X__ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person

(City)     (State)      (Zip)

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security
    (Instr. 3)

2.Transaction Date
   (Month/Day/Year)

3.Transaction Code
   (Instr. 8)

4.Securities  Acquired (A) or
   Disposed of (D)  (Instr. 3, 4 and 5)

5.Amount of Securities Beneficially Owned at the end of Issuer's Fiscal Year 
(Instr. 3 and 4)

6.Ownership Form: Direct
 (D) or Indirect (I)
 (Instr. 4)

7.Nature of Indirect Beneficial Ownership
 (Instr. 4)

Amount

(A) or (D)

Price

Common Stock 11/07/00 P 2,999,999 A $.00967  2,999,999  I   By Doubletree Capital Partners, Inc.
Common Stock 12/01/97 P        1,250,000 D  

* If the form is filed by more than one reporting person, see instruction 4(b)(v).

 

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts calls warrants options, convertible securities)

1.Title of
   Derivative
   Security
(Instr. 3)

2.Conversion
   or  Exercise
   Price of
 Derivative
   Security

3.Trans-
   action
   Date
   (Month/
   Day/
   Year)

4.Trans-
   action
   Code
   (Instr. 8)

5.Number of
   Derivative
   Securities
   Acquired
   (A) or
   Disposed
   of (D)
   (Instr. 3, 4
   and 5)

6.Date Exercisable
  and Expiration Date
  (Month/Day/Year)

7.Title and
   Amount of
   Underlying
   Securities
 (Instr. 3 and
    4)

8.Price of Derivative
 Security
(Instr. 5)

9.Number of
 Derivative
 Securities
Beneficially
Owned at End
   of Year
 (Instr. 4)

10.Ownership of     Derivative
  Security: Direct
     (D) or Indirect (I)
 (Instr. 4)

11.Nature of   Indirect
 Beneficial
     Ownership
     (Instr. 4)

(A)

(D)

Date Exercisable

Expiration Date

Title

Amount or Number of Shares

Convertible Preferred $.0000571 11/07/00

  P

 17,500,000

  

 At any time None Common Stock 17,500,000 $.0000571 17,500,000  I

By Doubletree Capital Partners, Inc.   

Convertible Loan Shares $.02 Various

  P

 17,249,200

  

 At any time None

Common Stock  

 17,249,200 $.02 17,249,200  I

By Doubletree Capital Partners, Inc.  

Anti-Dilution Common Shares Unknown Unknown

  P

 Unknown

  

 At any time None

Common Stock

 Unknown

  Unknown

  Unknown

  I

By Doubletree Capital Partners, Inc.  

Common Stock Warrants $1.00 12/01/97

  A

  

  

        

  

  450,000

  D

  

Explanation of Responses:

Table II: Convertible Preferred Stock pursuant to reorganization agreement between ISA Internationale, Inc. and Doubletree Capital Partners, Inc. dated November 7, 2000 and convertible at the option of Doubletree Capital Partners, Inc.

Convertible loans made by Doubletree Capital Partners, Inc. to Company are convertible at $.02 per share at the option of Doubletree Capital Partners, Inc.

ISAI common shares due Doubletree Capital Partners, Inc. to equal no less than 75% of all then outstanding common shares after converting ISAI convertible preferred shares and ISAI convertible loan shares.

/S/Bernard L. Brodkorb
**Signature of Reporting Person

July 31, 2002
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.