SC 13G 1 d25116_sc13g.txt SCHEDULE 13-G SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 SCHEDULE 13G INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13D-1 AND 13D-2 UNDER THE SECURITIES EXCHANGE ACT OF 1934 (THE "ACT") USA Video Interactive Corp. -------------------------------------------------------------------------------- (Name of Issuer) Common Shares, no par value -------------------------------------------------------------------------------- (Title of Class of Securities) 902924 20 8 -------------------------------------------------------------------------------- (CUSIP Number) December 31, 2000 -------------------------------------------------------------------------------- (Date of Event Which Requires Filing of this Statement) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: [_] Rule 13d-1(b) [_] Rule 13d-1(c) [X] Rule 13d-1(d) * The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). 2 ________________________________________________________________________________ 1. NAME OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Edwin Molina ________________________________________________________________________________ 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP: (a) [_] (b) [_] Not applicable ________________________________________________________________________________ 3. SEC USE ONLY ________________________________________________________________________________ 4. CITIZENSHIP OR PLACE OF ORGANIZATION United States ________________________________________________________________________________ NUMBER OF 5. SOLE VOTING POWER SHARES 5,957,924 common shares _________________________________________________________________ BENEFICIALLY 6. SHARED VOTING POWER OWNED BY 0 _________________________________________________________________ EACH 7. SOLE DISPOSITIVE POWER REPORTING 5,957,924 common shares _________________________________________________________________ PERSON 8. SHARED DISPOSITIVE POWER ________________________________________________________________________________ 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 5,957,924 common shares (1) ________________________________________________________________________________ 10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* Not applicable [_] ________________________________________________________________________________ 11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 6.91% (See response to Item 4). ________________________________________________________________________________ 12. TYPE OF REPORTING PERSON* IN ________________________________________________________________________________ (1) See note 1 of Item 4(a) below Item 1(a). Name of Issuer: USA Video Interactive Corp. Item 1(b). Address of Issuer's Principal Executive Offices: 70 Essex Street Mystic, Connecticut 06355 Item 2(a). Name of Person Filing: Edwin Molina Item 2(b). Address of Principal Business Office, or if None, Residence: 70 Essex Street Mystic, Connecticut 06355 Item 2(c). Citizenship: United States Item 2(d). Title of Class of Securities: Common shares, no par value Item 2(e). CUSIP Number: 902924 20 8 Item 3. If this statement is filed pursuant to Rule 13d-1(b), or 13d-2(b) or (c), check whether the person filing is a: (a) [ ] Broker or dealer registered under Section 15 of the Act; (b) [ ] Bank as defined in Section 3(a)(6) of the Act; (c) [ ] Insurance Company as defined in Section 3(a)(19) of the Act; (d) [ ] Investment Company registered under Section 8 of the Investment Company Act; (e) [ ] Investment Adviser registered under Section 203 of the Investment Advisers Act of 1940; (f) [ ] Employee Benefit Plan, Pension Fund which is subject to the provisions of the Employee Retirement Income Security Act of 1974 or Endowment Fund; see Rule 13d-1(b)(1)(ii)(F); (g) [ ] Parent Holding Company, in accordance with Rule 13d-1(b)(1)(ii)(G); see Item 7, 3 (h) [ ] A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813); (i) [ ] A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3); (j) [ ] Group, in accordance with Rule 13d-1(b)(1)(ii)(H). Not applicable Item 4. Ownership. (a) Amount beneficially owned: 5,957,924 common shares (1) (1) The Reporting Person beneficially owns in the aggregate, 5,957,924 common shares of which: 4,097,924 common shares are currently held (250,000 of these shares being acquired after December 31, 2000); 660,000 common shares are issuable upon the exercise of share purchase warrants (of which warrants for 250,000 of these shares were acquired after December 31, 2000); and 1,200,000 common shares are issuable upon the exercise of stock options, such warrants and options being fully vested and exercisable as of the date of this filing. Each common share entitles the holder to one vote per share. (b) Percent of class: 6.91% (c) Number of shares as to which such person has: (i) Sole power to vote or to direct the vote: 5,957,924 common shares (ii) Shared power to vote or to direct the vote: 0 (iii) Sole power to dispose or to direct the disposition of: 5,957,924 common shares (iv) Shared power to dispose or to direct the disposition of: 0 Item 5. Ownership of Five Percent or Less of a Class. Not applicable Item 6. Ownership of More than Five Percent on Behalf of Another Person. Not applicable Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company. Not applicable Item 8. Identification and Classification of Members of the Group. Not applicable Item 9. Notice of Dissolution of Group. Not applicable Item 10. Certification. Not applicable SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. March 16, 2001 -------------------------------------------- Date /s/ Edwin Molina -------------------------------------------- Signature Edwin Molina -------------------------------------------- Name/Title