4 1 d01363be4.htm FORM 4 Active Link Communications, Inc.
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 4

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(h) of the Investment Company Act of 1940

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

1. Name and Address of Reporting
Person*
2. Issuer Name and Ticker or Trading
Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Hall, Donnette L.
(Last) (First) (Middle)
  Active Link Communications, Inc. (ACVE)
 
     
  180 E. Pearson Street
Unit 3301

(Street)
4. Statement for Month/Day/Year 5. If Amendment, Date of Original (Month/Day/Year)
    6/27/02
 
     
    6. Relationship of Reporting Person(s)
to Issuer
(Check All Applicable)
7. Individual or Joint/Group Filing
(Check Applicable Line)
  Chicago, Illinois 60611
(City)        (State)        (Zip)
  o  Director x  10% Owner   x Form Filed by One Reporting Person
    o  Officer (give title below)   o Form Filed by More than One Reporting Person
    o  Other (specify below)  
     
     

Reminder:   Report on a separate line for each class of securities beneficially owned directly or indirectly.
 
*   If the form is filed by more than one reporting person, see instruction 4(b)(v).


 

                                               

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

1. Title of Security
(Instr. 3)
2. Transaction
Date

(Month/Day/Year)
2A. Deemed Execution
Date, if any

(Month/Day/Year)
3. Transaction
Code

(Instr. 8)
4. Securities Acquired (A) or
Disposed of (D)

(Instr. 3, 4 and 5)
5. Amount of Sec-
urities Beneficially
Owned Following
Reported Trans-
action(s)

(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)

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

(Instr. 4)

              Code V   Amount (A)
or
(D)
Price          

                         

                         

                         

                         

                         

                         

                         

                         

                         

                         

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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. Transaction
Date

(Month/Day/Year)
3A.  Deemed Execution
Date, if any

(Month/Day/Year)
4. Transaction
Code

(Instr. 8)
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)

(Instr. 3, 4 and 5)

                      Code V   (A) (D)

  Convertible Promissory Note     $.25     6/27/02     P   $500,000(1)

  Warrant (Right to Buy)     $.25     6/27/02     P   250,000

               

               

               

               

               

               

               

               

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

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 Following
Reported Transaction(s)

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

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

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

  6/27/02 (1)   Common Stock 2,000,000(1)     $500,000(2)       $2,500,000(3)     D  

  6/27/02 12/26/07   Common Stock 250,000     (2)       500,000     D  

                   

                   

                   

                   

                   

                   

                   

                   

Explanation of Responses:

(1) The Note may be converted at any time prior to payment. Accrued interest may also be converted which would increase the number of shares of common stock underlying the convertible promissory note.

(2) The Reporting Person paid $500,000 to the Issuer and received both the convertible promissory note and the warrant.

(3) Includes (i) a promissory note in the principal amount of $1,500,000 made by a shareholder, officer and director of the Issuer on September 29, 2001 convertible at the rate of one share of the Issuer's common stock for each $1.00 of debt; (ii) a convertible promissory note in the principal amount of $500,000 made by the Issuer on February 21, 2002 convertible at the rate of one share of the Issuer's common stock for each $.25 of debt. Accrued interest may also be converted on these obligations which would increase the number of shares of common stock underlying the notes.

/s/ Donnette L. Hall   November 13, 2002

**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 is insufficient, see Instruction 6 for procedure.

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