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*
Commonwealth Associates L.P.
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(Last) (First) (Middle)
830 Third Avenue
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(Street)
New York, New York 10022
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(City) (State) (Zip)
December, 1999
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2. Date of Event Requiring Statement (Month/Day/Year)
13-3467952
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3. IRS Identification Number of Reporting Person, if an entity (Voluntary)
Intelispan, Inc. (NASDAQOTC: IPVNE)
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4. Issuer Name and Ticker or Trading Symbol
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
|X| Director |X| 10% Owner
|_| Officer (give title below) |_| Other (specify below)
Michael S. Falk is a director
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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)
|_| Form filed by One Reporting Person
|X| Form filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
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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<S> <C> <C> <C>
Common Stock(1) 60,000 D
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Common Stock 9,383,333 I (2)
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Common Stock 566,666 I (3)
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Common Stock 1,426,664 I (4)
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</TABLE>
* 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.
Page 1 of 2
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FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
<TABLE>
<CAPTION>
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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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<S> <C> <C> <C> <C> <C> <C> <C>
Warrants to purchase
Common Stock (1) immed 12/23/06 Common Stock 9,300,667 $0.75 D
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Warrants to purchase
Common Stock (1) immed 1/14/07 Common Stock 1,007,261 $0.75 D
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Warrants to purchase
Common Stock (1) immed 2/3/07 Common Stock 650,000 $0.75 D
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Warrants to purchase
Common Stock immed 12/21/04 Common Stock 66,667 $0.75 I (2)
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Warrants to purchase
Common Stock immed 12/21/04 Common Stock 283,334 $0.75 I (3)
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Warrants to purchase
Common Stock immed 1/14/07 Common Stock 3,751,258 $0.75 I (3)
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Warrants to purchase
Common Stock immed 12/21/04 Common Stock 713,336 $0.75 I (4)
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Warrants to purchase
Common Stock immed 1/14/07 Common Stock 1,368,954 $0.75 I (5)
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</TABLE>
Explanation of Responses:
See attached footnotes.
Commonwealth Associates L.P.
By: Commonwealth Associates Management Corp., its general partner
/s/ Joseph Wynne August 1, 2000
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** Signature of Reporting Person Date
J. Wynne
Chief Financial Officer
** 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.
Page 2 of 2
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Page 3
FOOTNOTES
(1) These shares and warrants are owned directly by Commonwealth Associates L.P
("Commonwealth"). Michael S. Falk ("Falk"), Robert Priddy ("Priddy"), Keith
Rosenbloom ("Rosenbloom") and Basil Ascuitto ("Ascuitto") are directors and
shareholders of Commonwealth Associates Management Corp., the general partner of
Commonwealth ("CAMC"). Falk is the Chairman, CEO and principal stockholder of
CAMC. Each of Falk, Priddy, Rosenbloom and Ascuitto disclaim beneficial
ownership of the shares and warrants held by Commonwealth other than that
portion which corresponds with each of their equity ownership in CAMC.
(2) These shares and warrants are owned directly by ComVest Capital Partners LLC
("ComVest"). Falk, Priddy and Rosenbloom are the Managers and principal members
of ComVest. Each of Falk, Priddy and Rosenbloom disclaim beneficial ownership of
the shares and warrants held by ComVest other than that portion which
corresponds with each of their membership interest in ComVest.
(3) These shares and warrants are owned directly by Falk.
(4) These shares and warrants are owned directly by one or more of the following
individuals: Priddy, Rosenbloom or Ascuitto.
(5) These warrants are owned directly by Rosenbloom or Ascuitto.
<PAGE>
JOINT FILER INFORMATION
Name: Commonwealth Associates L.P.
830 Third Avenue
New York, New York 10022
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: Intelispan, Inc. (IPVNE)
Statement Date: December 1999
Signature: By: Commonwealth Associates Management Corp.,
its General Partner
By: /s/ Joseph Wynne
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Joseph Wynne, Chief Financial Officer
Name: Commonwealth Associates Management Corp.
830 Third Avenue
New York, New York 10022
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: Intelispan, Inc. (IPVNE)
Statement Date: December 1999
Signature: By: /s/ Joseph Wynne
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Joseph Wynne, Chief Financial Officer
Name: ComVest Capital Partners, LLC
830 Third Avenue
New York, New York 10022
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: Intelispan, Inc. (IPVNE)
Statement Date: December 1999
Signature: By: /s/ Michael S. Falk
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Michael S. Falk, Manager
Page 4 of 5
<PAGE>
Name: Michael S. Falk
830 Third Avenue
New York, New York 10022
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: Intelispan, Inc. (IPVNE)
Statement Date: December 1999
Signature: /s/ Michael S. Falk
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Michael S. Falk
Name: Keith Rosenbloom
830 Third Avenue
New York, New York 10022
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: Intelispan, Inc. (IPVNE)
Statement Date: December 1999
Signature: /s/ Keith Rosenbloom
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Keith Rosenbloom
Name: Basil Asciutto
830 Third Avenue
New York, New York 10022
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: Intelispan, Inc. (IPVNE)
Statement Date: December 1999
Signature: /s/ Basil Asciutto
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Basil Asciutto
Name: Robert Priddy
RMC Capital
1640 Powers Ferry, Suite 125
Marietta, Georgia 30067
Designated Filer: Commonwealth Associates L.P.
Issuer & Ticker Symbol: Intelispan, Inc. (IPVNE)
Statement Date: December 1999
Signature: /s/ Robert Priddy
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Robert Priddy