-----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, Kqz4FmZhTtYqGMpc5FgDxq1+fxPH3ioLY+jJNsolzGRi3e3SGSKrYphYyVjfwXI/ Bo9i+0oG3uHdbVjfLm6mcw== 0000898432-03-001213.txt : 20031205 0000898432-03-001213.hdr.sgml : 20031205 20031205151758 ACCESSION NUMBER: 0000898432-03-001213 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030613 FILED AS OF DATE: 20031205 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KIMBERLIN KEVIN CENTRAL INDEX KEY: 0000904841 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-28008 FILM NUMBER: 031040241 BUSINESS ADDRESS: STREET 1: SPENCER TRASK SECURITIES INC STREET 2: 535 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2123555565 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SMARTSERV ONLINE INC CENTRAL INDEX KEY: 0001005698 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 133750708 STATE OF INCORPORATION: DE FISCAL YEAR END: 0902 BUSINESS ADDRESS: STREET 1: METRO CENTER STREET 2: ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 BUSINESS PHONE: 2033535950 MAIL ADDRESS: STREET 1: ONE STATION PLACE CITY: STAMFORD STATE: CT ZIP: 06902 3 1 smartserv-spencert_3ex.xml X0201 3 2003-06-13 0 0001005698 SMARTSERV ONLINE INC SSOL 0000904841 KIMBERLIN KEVIN SPENCER TRASK SECURITIES INC 535 MADISON AVENUE NEW YORK NY 10022 0 0 1 0 Common Stock 933329 I See Note 8% Convertible Note Due November 19, 2003 0.744 2003-05-19 2003-11-19 Common Stock 198926 I See Note 8% Convertible Note Due December 13, 2003 0.794 2003-06-13 2003-12-13 Common Stock 279597 I See Note Warrants 0.744 2003-05-19 2008-05-19 Common Stock 554396 I See Note Warrants 0.794 2003-06-13 2008-06-13 Common Stock 1157170 I See Note The 933,329 shares of common stock were acquired on June 13, 2003, and are held by Spencer Trask Ventures, Inc., a Delaware corporation and wholly-owned subsidiary of Spencer Trask & Co., a Delaware corporation, of which the reporitng person is the controlling stockholder. Notes convertible into 80,646 shares of common stock are held collectively by Spencer Trask Private Equity Fund I LP, Spencer Trask Private Equity Fund II LP and Spencer Trask Private Equity/Accredited Fund III, LLC. The reporting person is approximatley an 80% owner of the entity that is a 100% owner of the manager of such Funds. Notes convertible into 118,280 shares of common stock are held by Spencer Trask Investment Partners LLC, a Delaware limited liability company, of which the reporting person is the non-member manager. The notes reference in this footnote (2) were acquired by May 19, 2003. Notes convertible into 75,567 shares of common stock are held collectively by Spencer Trask Private Equity Fund I LP, Spencer Trask Private Equity Fund II LP and Spencer Trask Private Equity/Accredited Fund III, LLC. The reporting person is approximatley an 80% owner of the entity that is a 100% owner of the manager of such Funds. Notes convertible into 204,030 shares of common stock are held by Spencer Trask Investment Partners LLC, a Delaware limited liability company, of which the reporting person is the non-member manager. The notes reference in this footnote (3) were acquired by June 13, 2003. Warrants exercisable for 135,000 shares of common stock are held collectively by Spencer Trask Private Equity Fund I LP, Spencer Trask Private Equity Fund II LP and Spencer Trask Private Equity/Accredited Fund III, LLC. The reporting person is approximatley an 80% owner of the entity that is a 100% owner of the manager of such Funds. Warrants exercisable for 198,000 shares of common stock are held by Spencer Trask Investment Partners LLC, a Delaware limited liability company, of which the reporting person is the non-member manager. Warrants exercisable for 221,396 shares of common stock are held by Spencer Trask Ventures, Inc., a Delaware corporation and wholly-owned subsidiary of Spencer Trask & Co., a Delaware corporation, of which the reporting person is the controlling stockholder. CONTINUED IN NEXT FOOTNOTE The warrants referenced in footnote (4) were acquired by May 19, 2003. Warrants exercisable for 135,000 shares of common stock are held collectively by Spencer Trask Private Equity Fund I LP, Spencer Trask Private Equity Fund II LP and Spencer Trask Private Equity/Accredited Fund III, LLC. The reporting person is approximatley an 80% owner of the entity that is a 100% owner of the manager of such Funds. Warrants exercisable for 364,500 shares of common stock are held by Spencer Trask Investment Partners LLC, a Delaware limited liability company, of which the reporting person is the non-member manager. Warrants exercisable for 657,670 shares of common stock are held by Spencer Trask Ventures, Inc., a Delaware corporation and wholly-owned subsidiary of Spencer Trask & Co., a Delaware corporation, of which the reporting person is the controlling stockholder. CONTINUED IN NEXT FOOTNOTE The warrants referenced in footnote (6) were acquired by June 13, 2003. /s/ Kevin B. Kimberlin 2003-12-04 -----END PRIVACY-ENHANCED MESSAGE-----