-----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, Nm7gn6RRFFmqE7CkusLO+0HM3uEsr4LR1c9poIDJPaCYaaypVF7XwlEDJwwDjwCb 0wlS97iUM6r8YuVzSu6M5g== 0000918545-00-000006.txt : 20000210 0000918545-00-000006.hdr.sgml : 20000210 ACCESSION NUMBER: 0000918545-00-000006 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000131 FILED AS OF DATE: 20000209 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BALTIC INTERNATIONAL USA INC CENTRAL INDEX KEY: 0000918545 STANDARD INDUSTRIAL CLASSIFICATION: ARRANGEMENT OF TRANSPORTATION OF FREIGHT & CARGO [4731] IRS NUMBER: 760336843 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-26558 FILM NUMBER: 528608 BUSINESS ADDRESS: STREET 1: 5151 SAN FELIPE STREET 2: SUITE 1661 CITY: HOUSTON STATE: TX ZIP: 77056 BUSINESS PHONE: 7139619299 MAIL ADDRESS: STREET 1: 5151 SAN FELIPE STREET 2: SUITE 1661 CITY: HOUSTON STATE: TX ZIP: 77056 COMPANY DATA: COMPANY CONFORMED NAME: DAVIER HOMI M CENTRAL INDEX KEY: 0001045429 STANDARD INDUSTRIAL CLASSIFICATION: ARRANGEMENT OF TRANSPORTATION OF FREIGHT & CARGO [4731] DIRECTOR STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 6654 SE FREEWAY CITY: HOUSTON STATE: TX ZIP: 77074 BUSINESS PHONE: 2812423808 MAIL ADDRESS: STREET 1: 4198 GREYSTONE WAY CITY: SUGARLAND STATE: TX ZIP: 77479 4 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person HOMI M. DAVIER 6654 SOUTHWEST FREEWAY HOUSTON, TX 77074 2. Issuer Name and Ticker or Trading Symbol BALTIC INTERNATIONAL USA, INC. BISA 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year January 2000 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 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. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | | Transaction | or Disposed of (D) | Securities |ect | Beneficial Ownership | | | | | Beneficially |(D)or | | | | | | | A/| | Owned at |Indir | | | Date |Code|V| Amount | D | Price | End of Month |ect(I)| | ___________________________________________________________________________________________________________________________________| | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of |2.Con- |3. |4. |5.Number of |6.Date Exer |7.Title and Amount |8.Price|9.Number of |10.|11.Nature of| Derivative |version |Transaction | Derivative |cisable and | of Underlying |of Deri| Derivative |Dir| Indirect | Security |or | | | Securities |Expiration | Securities |vative | Securities |ect| Beneficial | |Exercise| | | Acquired(A) or|Date(Month/ | |Secu | Benefi |(D)| Ownership | |Price of| | | Disposed of(D)|Day/Year) | |rity | ficially |or | | |Deriva- | | | |Date |Expir | | | Owned at |Ind| | |tive | | | | A/|Exer- |ation | Title and Number | | End of |ire| | |Secu- | | | | | D |cisable |Date | of Shares | | Month |ct | | |rity | Date |Code|V| Amount | | | | | | |(I)| | ___________________________________________________________________________________________________________________________________| Warrants | $0.83 |1/31/00 | H | | 5000 | D | |1/31/00 |Common stock|5000 | | 20250 | D | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: /s/David A. Grossman, Attorney-in-Fact February 9, 2000 - ----------------------------------------- ----------------------- SIGNATURE OF REPORTING PERSON DATE -----END PRIVACY-ENHANCED MESSAGE-----