-----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, WgIqGAIOa4MaO4OKEGIghDs++BdmqSZeggMbjuhAW0Ra5g5CH5xJ0adlZ6klzV3r 0thVt20xiSPYfGMWMfwzig== 0000931763-99-000120.txt : 19990120 0000931763-99-000120.hdr.sgml : 19990120 ACCESSION NUMBER: 0000931763-99-000120 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990108 FILED AS OF DATE: 19990119 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PROACTIVE TECHNOLOGIES INC CENTRAL INDEX KEY: 0000722839 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 232265039 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 001-08662 FILM NUMBER: 99508196 BUSINESS ADDRESS: STREET 1: 7118 BEECH RIDGE TRAIL STREET 2: STE 402 CITY: TALLAHASSEE STATE: FL ZIP: 32312 BUSINESS PHONE: 9046685800 MAIL ADDRESS: STREET 1: 7118 BEECH RIDGE TRAIL STREET 2: SUITE 402 CITY: TALLAHASSEE STATE: FL ZIP: 32312 FORMER COMPANY: FORMER CONFORMED NAME: KEYSTONE MEDICAL CORPORATION DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: KEYSTONE MEDICAL CORP INC DATE OF NAME CHANGE: 19910103 COMPANY DATA: COMPANY CONFORMED NAME: LANCE CHILDRENS TRUST CENTRAL INDEX KEY: 0001077029 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 3821 STRATFORD ROAD N E CITY: ALTANTA STATE: GA ZIP: 30342 MAIL ADDRESS: STREET 1: 3821 STRATFORD ROAD N E CITY: ATLANTA STATE: GA ZIP: 30342 3 1 FORM 3 -------- FORM 3 -------- U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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* Lance Children's Trust -------------------------------------------------------------------------- (Last) (First) (MI) 3821 Stratford Road, N.E. -------------------------------------------------------------------------- (Street) Atlanta Georgia 30342 -------------------------------------------------------------------------- (City) (State) (Zip) 2. Date of Event Requiring Statement (Month/Day/Year) 1/8/99 - ------------------------------------------------------------------------------ 3. IRS or Social Security Number of Reporting Person (Voluntary) - ------------------------------------------------------------------------------ 4. Issuer Name and Ticker or Trading Symbol Proactive Technologies,Inc. (PTE) - ------------------------------------------------------------------------------ 5. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [ X ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) - ------------------------------------------------------------------------------ 6. If Amendment, Date of Original (Month/Day/Year) - ------------------------------------------------------------------------------ 7. Individual or Joint/Group Filing (Check Applicable Box) [ X ] Form filed by One Reporting Person [ ] Form filed by More than One Reporting Person TABLE I - Non-Derivative Securities Beneficially Owned - ------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ 1. Title of | 2. Amount of Securities | 3. Ownership Form: | 4. Nature of Security | Beneficially Owned | Direct (D) or | Indirect (Instr. 4) | (Instr. 4) | Indirect (I) | Beneficial | | (Instr. 5) | Ownership - ------------------------------------------------------------------------------ Common Stock | 3,600,000 shares | D | - ------------------------------------------------------------------------------ | | | - ------------------------------------------------------------------------------ | | | - ------------------------------------------------------------------------------ | | | - ------------------------------------------------------------------------------ | | | - ------------------------------------------------------------------------------ | | | - ------------------------------------------------------------------------------ | | | - ------------------------------------------------------------------------------ | | | - ------------------------------------------------------------------------------ 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 5(b)(iv). (Print or Type Responses) (Over) FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) - -------------------------------------------------------------------------------- 1. Title of Derivative | 2. Date Exercisable and Expiration Date Security (Instr. 4) | (Month/Day/Year) |--------------------------------------------------- | Date Exercisable | Expiration Date - -------------------------------------------------------------------------------- a) | | | | - -------------------------------------------------------------------------------- b) | | | | - -------------------------------------------------------------------------------- c) | | | | - -------------------------------------------------------------------------------- d) | | | | ================================================================================ - ------------------------------------------------------------------------------- 3. Title and Amount of | 4. Conversion or | 5. Ownership | 6. Nature of Securities Underlying | Exercise Price | Form of | Indirect Derivative Security | of Derivative | Derivative | Beneficial (Instr. 4) | Security | Security: | Ownership - -------------------------| | Direct (D) | (Instr. 5) | Amount of | | or | | Number of | | Indirect (I)| Title | Shares | | (Instr. 5) | - -------------------------------------------------------------------------------- | | | | a) | | | | | | | | - -------------------------------------------------------------------------------- | | | | b) | | | | | | | | - -------------------------------------------------------------------------------- | | | | c) | | | | | | | | - -------------------------------------------------------------------------------- | | | | d) | | | | | | | | - -------------------------------------------------------------------------------- Explanation of Responses: The filing of this Statement shall not be construed as an admission (a) that the person filing this Statement is, for the purposes of Section 16 of the Securities Exchange Act of 1934 (as amended), the beneficial owner of any equity securities covered by this Statement, or (b) that this Statement is legally required to be filed by such person. ** 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. 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 OMB Number. /s/ C. Beverly Lance, Trustee January 14, 1999 - ----------------------------------------- ------------------ **Signature of Reporting Person Date Page 2 -----END PRIVACY-ENHANCED MESSAGE-----