-----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, QrT5qk9lzptJeu3+ZVvZTavQCyGR4VBzUIAD4AKnkdxkrvnMAccU9Hu0UqesGu+d 1FOkq7btgqbNGbj8eg4b9w== 0001108017-02-001536.txt : 20020607 0001108017-02-001536.hdr.sgml : 20020607 20020604155648 ACCESSION NUMBER: 0001108017-02-001536 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020501 FILED AS OF DATE: 20020604 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ADVA INTERNATIONAL INC CENTRAL INDEX KEY: 0000807732 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 161284228 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-16341 FILM NUMBER: 02670063 BUSINESS ADDRESS: STREET 1: BTC 454 S ANDERSON RD STREET 2: SUITE 214 CITY: ROCK HILL STATE: SC ZIP: 29730 BUSINESS PHONE: 8033276790 MAIL ADDRESS: STREET 1: BTC 454 S ANDERSON RD STREET 2: SUITE 214 CITY: ROCK HILL STATE: SC ZIP: 29730 FORMER COMPANY: FORMER CONFORMED NAME: ADVANCED MEDICAL PRODUCTS INC DATE OF NAME CHANGE: 19920703 COMPANY DATA: COMPANY CONFORMED NAME: VERDONCK ERNST R CENTRAL INDEX KEY: 0001174785 OFFICER IRS NUMBER: 161284228 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: BTC SUITE 214-454 S. ANDERSON RD. CITY: ROCK HILL STATE: SC ZIP: 29730 BUSINESS PHONE: 8033276790 MAIL ADDRESS: STREET 1: BTC SUITE 214 STREET 2: 464 S ANDERSON RD CITY: ROCK HILL STATE: SC ZIP: 29730 3 1 advaform3.htm 
                     U.S. SECURITIES AND EXCHANGE COMMISSION
                              Washington, DC 20549

                                     FORM 3

            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

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1.   Name and Address of Reporting Person*

Verdonck                              Ernst                Reinoud
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   (Last)                            (First)              (Middle)

Vondelstraat 118
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                                    (Street)

1054 GS  Amsterdam, The Netherlands
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   (City)                            (State)                (Zip)

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2.   Date of Event Requiring Statement (Month/Day/Year)

May 1, 2002
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3.   IRS Identification Number of Reporting Person, if an Entity (Voluntary)


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4.   Issuer Name and Ticker or Trading Symbol

ADVA International Inc.      ADII
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5.   Relationship of Reporting Person to Issuer
     (Check all applicable)

     [X]  Director                             [_]  10% Owner
     [X]  Officer (give title below)           [_]  Other (specify below)

CEO, President and CFO
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6.   If Amendment, Date of Original (Month/Day/Year)


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7.   Individual or Joint/Group Filing  (Check applicable line)

     [X]  Form Filed by One Reporting Person

     [_]  Form Filed by More than One Reporting Person

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             Table I -- Non-Derivative Securities Beneficially Owned
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                                                                 3. Ownership Form:
                                      2. Amount of Securities       Direct (D) or
1. Title of Security                     Beneficially Owned         Indirect (I)       4. Nature of Indirect Beneficial Ownership
   (Instr. 4)                            (Instr. 4)                 (Instr. 5)            (Instr. 4)
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Common Stock Par Value $0.001               71,250                      D                    N/A
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If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v).

Reminder: Report on a separate line for each class of securities beneficially
          owned directly or indirectly.

                            (Print of Type Responses)

                                                                          (Over)


FORM 3 (continued)

              Table II -- Derivative Securities Beneficially Owned
         (e.g., puts, calls, warrants, options, convertible securities)

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                                                                                                        5. Owner-
                                                    3. Title and Amount of Securities                      ship
                                                       Underlying Derivative Security                      Form of
                         2. Date Exercisable           (Instr. 4)                                          Derivative
                            and Expiration Date     ---------------------------------    4. Conver-        Security:
                            (Month/Day/Year)                               Amount           sion or        Direct      6. Nature of
                         ----------------------                            or               Exercise       (D) or         Indirect
                         Date       Expira-                                Number           Price of       Indirect       Beneficial
1. Title of Derivative   Exer-      tion                                   of               Derivative     (I)            Ownership
   Security (Instr. 4)   cisable    Date            Title                  Shares           Security       (Instr. 5)     (Instr. 5)
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Explanation of Responses:

/s/ Ernst Reinoud Verdonck                               June 4, 2002
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      **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 of Type Responses)

                                                                          Page 2
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