-----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, IZhHmlIA9VNuAL+CrEBSIEWMedygqJEDflM1soL/ZTDVf3bMO7A+F25KzZV9IDAg xx3knL19Lg9sPGHkBPCEBQ== 0001105944-02-000043.txt : 20021003 0001105944-02-000043.hdr.sgml : 20021003 20021002185812 ACCESSION NUMBER: 0001105944-02-000043 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021002 FILED AS OF DATE: 20021003 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: CAMPOS ELIZABETH CENTRAL INDEX KEY: 0001105943 RELATIONSHIP: OTHER IRS NUMBER: 95429631 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 900 WILSHIRE BLVD STREET 2: #500 CITY: LOS ANGELES STATE: CA ZIP: 90017 MAIL ADDRESS: STREET 2: 900 WILSHIRE BOULEVARD CITY: LOS ANGELES STATE: CA ZIP: 90017 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTERCARE COM DX INC CENTRAL INDEX KEY: 0001103310 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 954304537 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-31281 FILM NUMBER: 02780207 BUSINESS ADDRESS: STREET 1: 900 WILSHIRE BLVD #500 CITY: LOS ANGELES STATE: CA ZIP: 90017 MAIL ADDRESS: STREET 1: 900 WILSHIRE BLVD #500 CITY: LOS ANGELES STATE: CA ZIP: 90017 FORMER COMPANY: FORMER CONFORMED NAME: INTERCARE COM INC DATE OF NAME CHANGE: 20000114 3 1 form3100202.txt INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES-FORM
- ----------------- U.S. SECURITIES AND EXCHANGE COMMISSION ---------------------------- | F O R M 3| Washington, D.C. 20549 | OMB APPROVAL | - ----------------- |--------------------------| INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES |OMB Number 3235-0287| [ ] Check this box if |Expires: September 30,1998| no longer Subject Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, |Estimated ave. burden | to Section 16. Section 17(a) of the Public Utility Holding Company Act of 1935 or |hours per response.....0.5| Section 30(f) of the Investment Company Act 1940 ---------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ |1.Name and Address of Reporting Person* |2.Issuer Name and Ticker or Trading Symbol |6.Relationship of Reporting Person to | | Campos Eizabeth B. | InterCare.com-Dx, Inc. | Issuer (Check all Applicable) | | | Ticker Symbol: ICCO | | | | | Director 10% Owner | |----------------------------------------|------------------------------------------------|--- --- | | (Last) (First) (MI)|3.IRS or Soc. Sec. No. |4.Statement for Month/ | Officer X Other | | | of Reporting Person | Year |---(give title below) ---(Specify below)| | 10314 Western Avenue #101 | (Voluntary) | 10/02 | Employee | | | | |----------------------------------------| |----------------------------------------| |------------------------|7. Individual or Joint/Group Filing | | (Street) | |5.If Amendment, Date of | (Check Applicable Line) | | Downey California 90241 | | Original (Month/Year) | | | | | | X Form filed by One Reporting Person | | | | |--- | | | | | Form filed by More than One | | | | |--- Reporting Person | |----------------------------------------------------------------------------------------------------------------------------------| | (City) (State) (Zip) | | TABLE I - Non-Derivative Securities Acquired, Disposed of or Beneficially Owned | |----------------------------------------------------------------------------------------------------------------------------------| |1.Title of Security |2.Transac- |3.Trans. |4.Security Acquired (A) or |5.Amount of |6. |7.Nature of Indirect| | (Instr. 3) | tion Date | Code | Disposed of (D) | Securities |Own.| Beneficial | | |(Mon/Day/Yr)|(Instr.8)| (Instr. 3, 4 & 5) | Beneficially |Form| Ownership | | | |---------|-------------------------------| Owned at End of|(D) | (Instr. 4) | | | | | | |(A) | | Month |or | | | | |Code| V | Amount |(D) | Price | (Instr. 3 & 4) |(I) | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | Common Stock | 10/01/02 | | | 100,000 | A |$0.002/sh| 108,697 | D | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| | Common Stock | 02/22/01 | | | 8,697 | A |$0.002/sh| 8,697 | D | | | | | | | | | | | | | |-------------------------------|------------|----|----|----------------|----|---------|-----------------|----|--------------------| - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class securities owned directly or indirectly. SEC 1474 (7-98) *If the form is filed by more than one reporting person, see Instruction 4(b)(v). PAGE: 1 OF 2
FORM 4 (continued) TABLE II - Derivative Securities Acquired, Disposed of, Beneficially Owned (e.g., puts, calls, warrants, options, convertible security) - ------------------------------------------------------------------------------------------------------------------------------------ |1.Title of|2.Conver-|3. |4.Tran- |5.Number of |6.Date |7.Title and Amount |8.Price of|9.Number |10. |11.Nature | |Derivative|sion or |Trans| saction| Derivative |Exercisable| of Underlying |Derivative| of |Own.| of | |Security |Exercise |Date | Code | Securities |and | Securities |Security |Derivative|Form|Indirect | |(Instr. 3)|Price of |(Mon/|(Instr.8)| Acquired (A) or |Expiration | (Instr. 3 & 4) |(Instr. 5)|Securities|of |Beneficial| | |Deriva- | Day/| | Disposed of (D) |Date | | |Benefi- |Deri|Ownership | | |tive |Year)| | (Instr. 3, 4 & 5) |(Month/Day/| | |cially |Sec.|(Instr. 4)| | |Security | | | | Year) | | |Owned at |Dir.| | | | | | | |-----------|---------------------| |End of |(D) | | | | | | | | | | |Amount or | |Month |or | | | | | |---------|---------------------|Date |Exp. | Title |Number of | |(Instr. 4)|Ind.| | | | | |Code| V | (A) | (D) |Exbl.|Date | |Shares | | |(I) | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | |----------|---------|-----|----|----|----------|----------|-----|-----|----------|----------|----------|----------|----|----------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: **Intentional misstatements or omissions of facts constitute Federal /s/ Elizabeth Campos 10/02/2002 Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). -------------------------------------------- ---------- **Signature of Reporting Person Date Note: File three copies of this form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. SEC 1474 (7-98) Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMD Number
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