-----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, KC5VtL6QDvPJDNbcYsQXdlqQAYaZsVJP2S5x3B36LMh35dUgyLcZTiqqcDOrkJkz PcvucjdhHwOUJhEysr6k5g== 0000914121-00-000035.txt : 20000110 0000914121-00-000035.hdr.sgml : 20000110 ACCESSION NUMBER: 0000914121-00-000035 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991130 FILED AS OF DATE: 20000107 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: OFFICIAL PAYMENTS CORP CENTRAL INDEX KEY: 0001094998 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 522190781 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-28187 FILM NUMBER: 503152 BUSINESS ADDRESS: STREET 1: 2333 SAN RAMON VALLEY BOULEVARD STREET 2: SUITE 450 CITY: SAN RAMON STATE: CA ZIP: 94583 BUSINESS PHONE: 9258387996 MAIL ADDRESS: STREET 1: 2333 SAN RAMON VALLEY BOULEVARD STREET 2: SUITE 450 CITY: SAN RAMON STATE: CA ZIP: 94583 FORMER COMPANY: FORMER CONFORMED NAME: US AUDIOTEX CORP DATE OF NAME CHANGE: 19990914 COMPANY DATA: COMPANY CONFORMED NAME: BELTON BRAD CENTRAL INDEX KEY: 0001100618 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 2333 SAN RAMON VALLEY BLVD STREET 2: SUITE 450 CITY: SAN RAMON STATE: CA ZIP: 94583 MAIL ADDRESS: STREET 1: 2333 SAN RAMON VALLEY BLVD STREET 2: SUITE 450 CITY: SAN RAMON STATE: CA ZIP: 94583 4 1 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP - ------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------ FORM 4 Washington, D.C. 20549 OMB Approval - ------------------------- STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ------------------------------ [ ] Check this box if no OMB Number: 3235-0287 longer subject to Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Expires: December 31, 2001 Section 16. Form 4 Section 17(a) of the Public Utility Holding Company Act of 1935 or Estimated average burden or Form 5 obligations Section 30(f) of the Investment Company Act of 1940 hours per response.......0.5 may continue. See ------------------------------ Instruction 1(b).
(Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker 4. Statement for 6. Relationship of Reporting Person(s) or Trading Symbol Month/Year to Issuer (Check all applicable) Belton, Brad Official Payments 11/99 [ ] Director [ ] 10% Owner ------------------------------------ Corporation, OPAY [X] Officer (give [ ] Other (Last) (First) (Middle) title below) (specify below) 2333 San Ramon Valley Boulevard Vice President, Engineering Suite 450 --------------------------------------- ------------------------------------ ----------------------------------------------------------------------------------------- (Street) 3. I.R.S. Identification 5. If Amendment, 7. Individual or Joint/Group Filing Number of Reporting Date of (Check Applicable Line) Person, if an entity Original [X] Form Filed by One Reporting Person San Ramon, CA 94583 (Voluntary) (Month/Year) [ ] Form Filed by More than One ------------------------------------ Reporting Person (City) (State) (Zip) 11/99 - ------------------------------------------------------------------------------------------------------------------------------------ TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action Code (Instr. or Disposed of (D) Securities Form: Indirect Date 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Beneficial (Month/ Owned at End or Indirect Ownership Day/ of Month (I) (Instr. 4) Year) (Instr. 3 (Instr. 4) and 4) - ------------------------------------------------------------------------------------------------------------------------------------ Code V Amount (A) or (D) Price - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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). Page 1 of 2 SEC 1475 (3-99)
FORM 4 (continued)
TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date 7. Title 8. Price 9. Number 10. Owner- 11. Nature of of sion or action action Derivative Exer- and of of ship Indirect Deri- Exercise Date Code Securities cisable Amount Deri- Deri- Form Beneficial vative Price of (Instr. Acquired (A) and Expi- of vative vative of Deri- Ownership Secu- Deri- (Month/ 8) or Disposed ration Under- Secu- Secu- vative (Instr. 4) rity vative Day/ of (D) Date lying rity rities Security: (Instr. Security Year) (Instr. 3, (Month/ Securi- (Instr. Benefi- Direct 3) 4, and 5) Day/ ties 5) cially (D) or Year) (Instr. Owned Indirect 3 and 4) at End (I) of (Instr. Month 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Code V (A) (D) Date Expir- Title Amount Exerci- ation or sable Date Number of Shares - ------------------------------------------------------------------------------------------------------------------------------------ Employee $1.33 11/22/99 A V 3,588 Immed. 11/23/ Common 3,588 109,626 D Stock C 2009 Stock, Option par (Right to value Buy) $0.01 - ------------------------------------------------------------------------------------------------------------------------------------ Employee $15.00 11/22/99 A V 19,998 11/22/ 11/22/ Common 19,998 129,624 D Stock 2000 2009 Stock, Option (2) par (Right to value Buy) $0.01 - ------------------------------------------------------------------------------------------------------------------------------------ Employee $15.00 11/22/99 A V 90,545 Immed. 11/22/ Common 90,545 220,169 D Stock (3) 2009 Stock, Option par (Right to value Buy) $0.01 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) The option vests immediately upon the initial public offering, or November 22, 1999. (2) This option will first become vested and exercisable with respect to 6,666 shares on November 22, 2000. Thereafter, it will become vested and exercisable with respect to 555 additional shares on the last day of each of the next 23 consecutive months, with the balance of the 567 shares to become vested and exercisable on the last day of the 24th consecutive month. (3) The Right of Repurchase shall lapse, and full vesting will occur, with respect to 30,181 shares of the Common Stock subject to this Option on November 22, 2000. Thereafter, the Right of Repurchase shall lapse, and full vesting will occur, with respect to 2,515 additional shares of the Common Stock subject to this Option on the last day of each of the next 23 consecutive calendar months, with the balance of 2,519 shares of Common Stock to vest on the last day of the 24th consecutive month. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. and 15 U.S.C. 78ff(a). By: /S/ Brad Belton 1/6/00 -------------------------------------- --------------------------- ** Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless form displays a currently valid OMB number. Page 2 of 2 SEC 1475 (3-99)
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