4 1 0001.txt FORM 4 -------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION FORM 4 Washington, DC. 20549 -------------- STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [ ] Check this box if no longer OMB APPROVAL subject to Section 16. Form 4 or OMB Number 3235-0287 Form 5 obligations may continue. Expires: December 31, 2001 See Instruction 1(b). Estimated average burden hours per response..........0.5 (Print or Type Responses) -------------------------------------------------------------------------------- 1. Name and Address of Reporting 2. Issuer Name and Ticker or Trading Symbol Person* Latin American Casinos, Inc. (LACI) Augustine Fune, LP (Nasdaq National Market) -------------------------------------------------------------------------------- (Last) (First) (Middle) 3. IRS or Social 4. Statement for Security Month/Year Number of Reporting 141 W. Jackson, Suite 2182 Person (Voluntary) December 2000 -------------------------------------- ------------------- (Street) Chicago, IL 60604 -------------------------------------- (City) (State) (Zip) 5. If Amendment, Date of Original (Month/Year) 6. Relationship of 7. Individual or Joint/Group Reporting Person to Issuer Filing (Check Applicable Line) (Check all applicable) ___ Form filed by One Reporting Person ___ Director _X_ 10% Owner _X_ Form filed by More than ___ Officer (give ___ Other (specify One Reporting Person title below) below) --------------------------------------
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired 5. Amount of 6. Ownership 7. Nature of Instr. 3) action action (A) or Disposed of Securities Form: Indirect Date Code (D) (Instr. 3, 4 Beneficially Direct (D) Beneficial (Month/ (Instr. 8) and 5) Owned at End or Indirect Ownership Day/ ------------------------------------ of Month (I) (Instr. 4) Year) (A) or (Instr. 3 and (Instr. 4) Code V Amount (D) Price 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 12/07/00 X 325,000 A $1.25 325,000 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 4(b)(v). (Over) SEC 1474 (3-99)
Form 4 (continued) Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exercisable 7. Title and Amount Security sion or action action Derivative and Expiration of Underlying (Instr. 3) Exercise Date Code Securities Date (Month/Day/ Securities Price of (Month/ (Instr. Acquired (A) Year) (Instr. 3 and 4) Deri- Day/ 8) or Disposed ------------------------------------------ vative Year) of (D) Date Expira- Title Amount or Security (Instr. 3, 4 Exer- tion Number of and 5) cisable Date Shares ---------------------------- Code V (A) (D) ------------------------------------------------------------------------------------------------------------------------------------ Option to Buy Common Stock $1.75 12/7/00 X 325,000 Immed. Common Stock 325,000 ------------------------------------------------------------------------------------------------------------------------------------ 6% Convertible Debentures $1.75 12/14/00 P $800,000 Immed. 6/13/01 Common Stock 457,143 ------------------------------------------------------------------------------------------------------------------------------------ 6% Convertible Debentures $1.75 12/14/00 P $500,000 Immed. 6/13/01 Common Stock 285,174 ------------------------------------------------------------------------------------------------------------------------------------ 6% Convertible Debentures $1.75 12/14/00 P $50,000 Immed. 6/13/01 Common Stock 28,517 ------------------------------------------------------------------------------------------------------------------------------------ Warrant to Buy Common Stock $1.75 12/14/00 P 1,500,000 Immed. Common Stock 1,500,000 ------------------------------------------------------------------------------------------------------------------------------------ Warrant to Buy Common Stock $1.75 12/12/00 P 45,000 Immed. Common Stock 45,000 ------------------------------------------------------------------------------------------------------------------------------------ 8. Price 9. Number 10. Ownership 11. Nature of of Deriv- Form of of Deriv- ative Derivative Indirect ative Secu- Security; Bene- Secu- rities Direct (D) ficial rity Bene- or Indirect Own- (Instr. ficially (I) ership 5) Owned (Instr. 4) (Instr. 4) at End of Month (Instr. 4) -------------------------------------------------------------------------------- 0 D -------------------------------------------------------------------------------- $800,000 457,143 D -------------------------------------------------------------------------------- $500,000 285,174 D(1) -------------------------------------------------------------------------------- $50,000 28,517 D(2) -------------------------------------------------------------------------------- (5) 1,500,000 D(3) -------------------------------------------------------------------------------- (6) 45,000 D(4) -------------------------------------------------------------------------------- Explanation of Responses: (1) Beneficially owned solely by Brian Porter. (2) Beneficially owned solely by David M. Matteson. (3) Beneficially owned by all joint filers, through certain trusts controlled by them. (4) Beneficially owned solely by David M. Matteson. (5) Received by a related party to the joint filers from the Issuer in exchange for services rendered. (6) Received by David M. Matteson from the Issuer in exchange for services rendered.
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Augustine Fund, LP by Augustine Capital Management, LLC, general partner by John T. Porter, President /s/ John Porter January 12, 2001 -------------------------- --------------- ** 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. 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. Page 2 FORM 4 (CONTINUED) Additional Reporting Persons -------------------------------------------------------------------------------- Additional Reporting Person and Address: Each of the following additional filers is a general partner, officer or director of Augustine Fund, L.P., and may be deemed to have a pecuniary interest in the shares of Common Stock and the Debentures and Warrants beneficially owned by Augustine Fund, L.P. -------------------------------------------------------------------------------- Augustine Capital Management, LLC 141 W. Jackson, Suite 2182 Chicago, IL 60604 -------------------------------------------------------------------------------- John T. Porter 141 W. Jackson, Suite 2182 Chicago, IL 60604 -------------------------------------------------------------------------------- Brian D. Porter 141 W. Jackson, Suite 2182 Chicago, IL 60604 -------------------------------------------------------------------------------- Thomas Duszynski 141 W. Jackson, Suite 2182 Chicago, IL 60604 -------------------------------------------------------------------------------- David R. Asplund 141 W. Jackson, Suite 2182 Chicago, IL 60604 -------------------------------------------------------------------------------- David M. Matteson 141 W. Jackson, Suite 2182 Chicago, IL 60604 -------------------------------------------------------------------------------- Signatures of Additional Reporting Persons: Dated January 12, 2001 AUGUSTINE CAPITAL MANAGEMENT, LLC /s/ John T. Porter John T. Porter, President of general partner /s/ John T. Porter John T. Porter /s/ Brian D. Porter Brian D. Porter /s/ Thomas Duszynski Thomas Duszynski /s/ David R. Asplund David R. Asplund /s/ David M. Matteson David M. Matteson 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. Page 3