-----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, QYlJGPUerSmzvslquTQqsQLIJorijz1RQefyg5bSxvgFaXhNVZXLW/Zyn8hCr3nN OqvFtcXKMFI6FJAGVH4AjQ== 0001111848-02-000006.txt : 20020414 0001111848-02-000006.hdr.sgml : 20020414 ACCESSION NUMBER: 0001111848-02-000006 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020210 FILED AS OF DATE: 20020222 COMPANY DATA: COMPANY CONFORMED NAME: KUCHER MARK D CENTRAL INDEX KEY: 0001158695 OWNER FILING VALUES: FORM TYPE: 4 MAIL ADDRESS: STREET 1: 1410-700 WEST GEORGIA STREET STREET 2: VANCOUVER CITY: BRITISH COLUMBIA STATE: A1 ZIP: 00000 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: QUEPASA COM INC CENTRAL INDEX KEY: 0001078099 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-ADVERTISING [7310] IRS NUMBER: 860879433 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25565 FILM NUMBER: 02556043 BUSINESS ADDRESS: STREET 1: 7904 E CHAPPARAL ROAD STREET 2: SUITE A110 PMB #160 CITY: SCOTTSDALE STATE: AZ ZIP: 85250 BUSINESS PHONE: 6027160100 MAIL ADDRESS: STREET 1: ONE ARIZONA CENTER STREET 2: 400 E VAN BUREN CITY: PHOENIX STATE: AZ ZIP: 85004 4 1 form4.txt FORM 4 - QUEPASA.COM Form 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 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(f) of the Investment Company Act of 1940 (Print or Type Responses) 1. Name and Address of Reporting Person* Last First Middle Kucher Mark D. Street: 1226 Homer Street, Suite 301 City: Vancouver State: British Columbia, Canada Zip: V6B 2Y5 2. Issuer Name and Ticker or Trading Symbol Quepasa.com, Inc. (PASAE.OB) 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) 4. Statement for Month/Year January/2002 5. If Amendment, Date of Original (Month/Day/Year) 12/04/2001 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [__] Director [X] 10% Owner [__] Officer (give title below),[_] Other (specify below) 7. Individual or Joint/Group Filing (Check Applicable Line) [ ] Form filed by One Reporting Person [X] Form filed by More than One Reporting Person 1 of 6
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1.Title of 2.Transaction 3.Transaction 4.Securities 5.Amount of 6.Ownership 7.Nature of Security Date Code Acquired(A) Securities Form Direct(D) Indirect (Instr. 3) (Instr. 8) or Disposed Beneficically or Indirect(I) Beneficial of(D) Owned at End (Instr. 4) Ownership (Instr. 3,4,5) of Month (Instr. 4) (Instr. 3 & 4) Common Stock No Transaction No Transaction 2,386,243 Direct Since Filing of Since Filing of Form 3 Form 3 Common Stock 01/04/2002 J (A) 1,475,000 Indirect Informal voting group
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1.Title of 2.Date 3.Title and 4.Conversion 5.Ownership 6.Nature of Derivative Exercisable Amount of or Exercise Form of Indirect Security and Securities Price of Derivative Beneficial (Instr. 4) Expiration Underlying Derivative Securities: Ownership Date Derivative Security Direct (D) or (Instr. 5) (MM/DD/YY) Security Indirect (I) (Instr. 4) (Instr. 5) N/A
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: On January 04, 2002, Reporting Persons Kevin Dieball, Mark Kucher and Michael D. Silberman reached an informal verbal understanding to vote their collective shares as a group on all matters pertaining to corporate governance. While Mark D. Kucher is a direct beneficial owner of 13.90% of the Issuer's outstanding shares of common stock, he may be deemed by the SEC as an indirect benficial owner of 22.5% of the Issuer's outstanding common stock due to the verbal understanding reached by the Reporting Persons Kevin Dieball, Mark Kucher and Michael D. Silberman. /S/ Mark D. Kucher 02/10/2002 /s/ Michael D. Silberman 02/10/2002 /s/ Kevin Dieball 02/10/2002 **Signature of Reporting Persons Date * If the form is filed by more than one reporting person, see Instruction 5(b)(v). ** 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. 2 of 6 ATTACHMENT LIST OF ADDITIONAL REPORT REPORTING PERSONS 1. Name and Address of Reporting Person* Last First Middle Silberman Michael D. Street: 5314 Round Meadow Road City: Hidden Hills State: California Zip: 91302-1165 2. Issuer Name and Ticker or Trading Symbol Quepasa.com, Inc. (PASAE.OB) 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) 4. Statement for Month/Year January/2002 5. If Amendment, Date of Original (Month/Day/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [__] Director [ ] 10% Owner [__] Officer (give title below),[X] Other (specify below) While Michael D. Silberman is a direct beneficial owner of 6.21% of the Issuer's outstanding shares of common stock, he may be deemed by the SEC as an indirect benficial owner of 22.5% of the Issuer's outstanding common stock due to a verbal understanding reached by Reporting Persons Kevin Dieball, Mark Kucher and Michael D. Silberman reached an informal verbal understanding to vote their collective shares as a group on all matters pertaining to corporate governance. 7. Individual or Joint/Group Filing (Check Applicable Line) [ ] Form filed by One Reporting Person [X] Form filed by More than One Reporting Person 3 of 6
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1.Title of 2.Transaction 3.Transaction 4.Securities 5.Amount of 6.Ownership 7.Nature of Security Date Code Acquired(A) Securities Form Direct(D) Indirect (Instr. 3) (Instr. 8) or Disposed Beneficically or Indirect(I) Beneficial of(D) Owned at End (Instr. 4) Ownership (Instr. 3,4,5) of Month (Instr. 4) (Instr. 3 & 4) Common Stock 08/30/2001 P 20,000 (A) 0.18 Direct Common Stock 09/05/2001 P 20,000 (A) 0.18 Direct Common Stock 09/07/2001 P 25,000 (A) 0.21 Direct Common Stock 09/18/2001 P 50,000 (A) 0.21 Direct Common Stock 09/19/2001 P 30,000 (A) 0.21 Direct Common Stock 10/02/2001 P 25,000 (A) 0.21 Direct Common Stock 10/03/2001 P 75,000 (A) 0.21 Direct Common Stock 10/05/2001 P 10,000 (A) 0.20 Direct Common Stock 10/09/2001 P 22,000 (A) 0.21 Direct Common Stock 10/19/2001 P 20,000 (A) 0.21 Direct Common Stock 10/19/2001 P 68,000 (A) 0.21 Direct Common Stock 11/30/2001 P 700,000 (A) 0.15 1,065,000 Direct Common Stock 01/04/2002 J (A) 2,796,243 Indirect Informal voting group
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1.Title of 2.Date 3.Title and 4.Conversion 5.Ownership 6.Nature of Derivative Exercisable Amount of or Exercise Form of Indirect Security and Securities Price of Derivative Beneficial (Instr. 4) Expiration Underlying Derivative Securities: Ownership Date Derivative Security Direct (D) or (Instr. 5) (MM/DD/YY) Security Indirect (I) (Instr. 4) (Instr. 5) N/A
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: On January 04, 2002, Reporting Persons Kevin Dieball, Mark Kucher and Michael D. Silberman reached an informal verbal understanding to vote their collective shares as a group on all matters pertaining to corporate governance. On December 4, 2001, Reporting Person Mark D. Kucher filed an initial Form 3. This Form 4 is an amendment to that filing, and Reporting Persons, Kevin Dieball and Mark D. Silberman join this Form 4 filing in accordance with Instruction 4(b)(v). 4 of 6 1. Name and Address of Reporting Person* Last First Middle Dieball Kevin Street: 11252 East Appaloosa City: Scottsdale State: Arizona Zip: 85259 2. Issuer Name and Ticker or Trading Symbol Quepasa.com, Inc. (PASAE.OB) 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) 4. Statement for Month/Year January/2002 5. If Amendment, Date of Original (Month/Day/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [__] Director [ ] 10% Owner [__] Officer (give title below),[X] Other (specify below) While Reporting Person Kevin Dieball is a direct beneficial owner of 2.4% of the Issuer's outstanding shares of common stock, he may be deemed by the SEC as an indirect benficial owner of 22.5% of the Issuer's outstanding common stock due to a verbal understanding reached by Reporting Persons Kevin Dieball, Mark Kucher and Michael D. Silberman reached an informal verbal understanding to vote their collective shares as a group on all matters pertaining to corporate governance. 7. Individual or Joint/Group Filing (Check Applicable Line) [ ] Form filed by One Reporting Person [X] Form filed by More than One Reporting Person 5 of 6
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1.Title of 2.Transaction 3.Transaction 4.Securities 5.Amount of 6.Ownership 7.Nature of Security Date Code Acquired(A) Securities Form Direct(D) Indirect (Instr. 3) (Instr. 8) or Disposed Beneficically or Indirect(I) Beneficial of (D) Owned at End (Instr. 4) Ownership (Instr. 3,4,5) of Month (Instr. 4) (Instr. 3 & 4) Common Stock 12/11/2001 P 100,000 (A) 0.19 Direct Common Stock 12/18/2001 P 100,000 (A) 0.15 Direct Common Stock 12/18/2001 P 50,000 (A) 0.15 Direct Common Stock 12/18/2001 P 50,000 (A) 0.13 Direct Common Stock 12/19/2001 P 40,000 (A) 0.18 Direct Common Stock 12/20/2001 P 60,000 (A) 0.19 410,000 Direct Common Stock 01/04/2002 J (A) 3,451,243 Indirect Informal voting group
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1.Title of 2.Date 3.Title and 4.Conversion 5.Ownership 6.Nature of Derivative Exercisable Amount of or Exercise Form of Indirect Security and Securities Price of Derivative Beneficial (Instr. 4) Expiration Underlying Derivative Securities: Ownership Date Derivative Security Direct (D) or (Instr. 5) (MM/DD/YY) Security Indirect (I) (Instr. 4) (Instr. 5) N/A
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: On January 04, 2002, Reporting Persons Kevin Dieball, Mark Kucher and Michael D. Silberman reached an informal verbal understanding to vote their collective shares as a group on all matters pertaining to corporate governance. On December 4, 2001, Reporting Person Mark D. Kucher filed an initial Form 3. This Form 4 is an amendment to that filing, and Reporting Persons, Kevin Dieball and Mark D. Silberman join this filing in accordance with Instruction 4(b)(v). 6 of 6 -----END PRIVACY-ENHANCED MESSAGE-----