-----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, WB8WCdxBxhVfi+4LaXBXeaudnKdrpdg4AWCG9Ku7bWCMsIPz0E6MwvKsR0E1zwy2 kczhlU+xUlQbrbWPZTLBLg== 0001082990-01-000018.txt : 20010123 0001082990-01-000018.hdr.sgml : 20010123 ACCESSION NUMBER: 0001082990-01-000018 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010116 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MAS ACQUISITION XLI CORP CENTRAL INDEX KEY: 0001103045 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 352089919 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-28991 FILM NUMBER: 1509131 BUSINESS ADDRESS: STREET 1: 1710 E DIVISION ST CITY: EVANSVILLE STATE: IN ZIP: 47711 BUSINESS PHONE: 8124797266 MAIL ADDRESS: STREET 1: 1710 E DIVISION ST CITY: EVANSVILLE STATE: IN ZIP: 47711 COMPANY DATA: COMPANY CONFORMED NAME: TSAI AARON CENTRAL INDEX KEY: 0001082990 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 1710 E DIVISION STREET CITY: EVANSVILLE STATE: IN ZIP: 47711 BUSINESS PHONE: 8124797266 MAIL ADDRESS: STREET 1: 1710 EAST DIVISION STREET CITY: EVANSVILLE STATE: IN ZIP: 47711 5 1 0001.txt [DESCRIPTION]ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP FORM 5 / / Check box if no longer OMB APPROVAL subject to Section 16. OMB NUMBER: 3235-0362 Form 4 or Form 5 EXPIRES: SEPTEMBER 30, 1998 obligations may continue. ESTIMATED AVERAGE BURDEN See Instruction 1(b) HOURS PER RESPONSE 1.0 /X/ Form 3 Holdings Reported / / Form 4 Transactions Reported U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL 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 1. Name and Address of Reporting Person* Tsai Aaron (Last) (First) (Middle) 17 N. Governor St. (Street) Evansville IN 47711 (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol MAS Acquisition XLI Corp. (Common Stock: No Trading Symbol) 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year 12/00 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( V ) Director ( V ) 10% Owner ( V ) Officer (give title below) ( ) Other (specify below) President, Chief Executive Officer and Treasurer 7. Individual or Joint/Group Filing (Check applicable line) ( V ) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person * If Form is filed by more than one Reporting Person, see Instruction 4(b)(v). (Print or Type Responses) Page 1
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1. Title of Security 2. Transaction Date (Instr. 3) (Month/Day/Year) - - ------------------------------------- ----------------------- a. Common Stock, par value $.001 - - ------------------------------------- ----------------------- b. - - ------------------------------------- ----------------------- c. - - ------------------------------------- ----------------------- d. - - ------------------------------------- ----------------------- e. - - ------------------------------------- ----------------------- f. - - ------------------------------------- ----------------------- 3. Transaction 4. Securities Acquired (A) or Code Disposed of (D) (Instr. 8) (Instr. 3, 4 and 5) ------------------------------------------- Amount (A) or (D) Price - - ----------------- ------------- ------------- ------------- a. - - ----------------- ------------- ------------- ------------- b. - - ----------------- ------------- ------------- ------------- c. - - ----------------- ------------- ------------- ------------- d. - - ----------------- ------------- ------------- ------------- e. - - ----------------- ------------- ------------- ------------- f. - - ----------------- ------------- ------------- ------------- 5. Amount of Securities 6. Ownership Form: 7. Nature of Indirect Benificially Owned Direct (D) or Beneficial Ownership at End of Issuer's Fiscal Indirect (I) (Instr. 4) Year (Instr. 4) (Instr. 3 and 4) - - ----------------------------- ------------------ ----------------------- a. 8,250,350 I See explanation note 1 - - ----------------------------- ------------------ ----------------------- b. - - ----------------------------- ------------------ ----------------------- c. - - ----------------------------- ------------------ ----------------------- d. - - ----------------------------- ------------------ ----------------------- e. - - ----------------------------- ------------------ ----------------------- f. - - ----------------------------- ------------------ ----------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
(Print or Type Responses) Page 2
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g, puts, calls, warrants, options, convertible securities) 1. Title of 2. Conver- 3. Transac- 4. Transac- 5. Number of Derative sion or sion sion Derivative Security Exercise Date Code Securities (Instr. 3) Price (Month/ Acquired (A) or of Day/ (Instr. 8) Disposed of (D) Derivative Year) (Instr. 3, 4 and 5) Security -------------------- (A) (D) - - ------------ -------------- ---------- ------------- --------- ---------- a. - - ------------ -------------- ---------- ------------- --------- ---------- b. - - ------------ -------------- ---------- ------------- --------- ---------- c. - - ------------ -------------- ---------- ------------- --------- ---------- d. - - ------------ -------------- ---------- ------------- --------- ---------- e. - - ------------ -------------- ---------- ------------- --------- ---------- f. - - ------------ -------------- ---------- ------------- --------- ---------- 6. Date Exercisable 7. Title and Amount of Underlying 8. Price of and Expiration Securities Derivative Date (Instr. 3 and 4) Security (Month/Day/Year) (Instr. 5) - - --------------------------- --------------------------------- Date Expiration Title Amount or Exercisable Date Number of Shares - - --------------- ----------- ----------------- -------------- ------------- a. - - --------------- ----------- ----------------- -------------- ------------- b. - - --------------- ----------- ----------------- -------------- ------------- c. - - --------------- ----------- ----------------- -------------- ------------- d. - - --------------- ----------- ----------------- -------------- ------------- e. - - --------------- ----------- ----------------- -------------- ------------- f. - - --------------- ----------- ----------------- -------------- ------------- 9. Number of 10. Ownership 11. Nature of Derivative of Deriva- Indirect Securities tive Beneficial Beneficially Security: Ownership Owned at Direct (D) (Instr. 4) End of Year or Indirect (Instr. 4) (I) (Instr. 4) - ------------------- -------------------- ----------------- a. - ------------------- -------------------- ----------------- b. - ------------------- -------------------- ----------------- c. - ------------------- -------------------- ----------------- d. - ------------------- -------------------- ----------------- e. - ------------------- -------------------- ----------------- f. - ------------------- -------------------- -----------------
Explanation of Responses: (1) MAS Capital Inc. is controlled by Aaron Tsai. 8,250,000 shares are owned by MAS Capital Inc. and 350 shares are owned by John Tsai, brother of Aaron Tsai. /s/ Aaron Tsai January 9, 2001 - - ------------------------------- ---------------------- ** 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 provided is insufficient, see Instruction 6 for procedure. (Print or Type Responses) Page 3 -----END PRIVACY-ENHANCED MESSAGE-----