-----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, E9212Q8osMubsOLfYMvgs7BFI1NkSyIIFjJFFiMoVhyPRRYeSZ2KPq3JOSJcUh2v T9lw+Jz0S43InsjgGsi9Ow== /in/edgar/work/20000908/0000908662-00-000212/0000908662-00-000212.txt : 20000922 0000908662-00-000212.hdr.sgml : 20000922 ACCESSION NUMBER: 0000908662-00-000212 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000831 FILED AS OF DATE: 20000908 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: RESPONSE USA INC CENTRAL INDEX KEY: 0000889087 STANDARD INDUSTRIAL CLASSIFICATION: [7380 ] IRS NUMBER: 223088639 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-20770 FILM NUMBER: 719316 BUSINESS ADDRESS: STREET 1: 3 EXECUTIVE CAMPUS STREET 2: 2ND FLOOR SOUTH CITY: CHERRY HILL STATE: NJ ZIP: 08002 BUSINESS PHONE: 8566610700 MAIL ADDRESS: STREET 1: 3 EXECUTIVE CAMPUS STREET 2: 2ND FLOOR SOUTH CITY: CHERRY HILL STATE: NJ ZIP: 08002 COMPANY DATA: COMPANY CONFORMED NAME: QUEEN JEFFREY CENTRAL INDEX KEY: 0001103794 STANDARD INDUSTRIAL CLASSIFICATION: [ ]DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 777 YAMOTO ROAD, SUITE 350 CITY: BOCA RATON STATE: FL ZIP: 33431 BUSINESS PHONE: 8003261122 4 1 0001.txt FORM 4 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 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 box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ________________________________________________________________________________ 1. Name and Address of Reporting Person* Queen Jeffrey - -------------------------------------------------------------------------------- (Last) (First) (Middle) 777 Yamato Road, Suite 350 - -------------------------------------------------------------------------------- (Street) Boca Raton FL 33431 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Response USA, Inc. (RSPN) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year August 2000 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [X] Officer (give title below) [_] Other (specify below) Chief Executive Officer ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [_] Form filed by more than one Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.008 par value 08/16/00 J(1) 616,966(2) A (1) 858,484(2) I By Trust - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.008 par value 08/16/00 J(1) 1,235,632.79(3) A (1) 1,302,011.23(3) I By Zenex J1, L.L.C. - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.008 par value 08/16/00 J(1) 6,148.04(4) A (1) 6,516.60(4) I By Zenex A1, L.L.C. - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $.008 par value -- -- -- -- -- 409,323 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. 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. (Print or Type Responses) (Over) (Form 4-07/99) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) Pursuant to Amendment No. 1 to Settlement Agreement dated as of July 19, 2000 by and among Jeffrey Queen, Andrew Queen, Jeffrey Queen and Andrew Queen Irrevocable Trust U/A January 2, 1998 and the Issuer, the Issuer delivered to the reporting person the number of shares determined in accordance with the Agreement at an agreed value of $0.50 per share. (2) Held directly by the Jeffrey Queen and Andrew Queen Irrevocable Trust U/A January 2, 1998. The Reporting Person's children are beneficiaries of this Trust. (3) Held directly by Zenex J1, L.L.C., of which the Reporting Person is a member. (4) Held directly by Zenex A1, L.L.C., of which the Reporting Person is a member. By: /s/ Jeffrey Queen September 8, 2000 ---------------------------------------- ----------------------- **Signature of Reporting Person Date Jeffrey Queen ** 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. Page 2 -----END PRIVACY-ENHANCED MESSAGE-----