U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 5
ANNUAL 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 to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
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1. Name and Address of Reporting Person*
Johnson Paul R
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(Last) (First) (Middle)
1533 S.E. 9th Street
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(Street)
Deerfield Beach FL 33441
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
etravelserve.com, Inc./TSER.OB
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
06/00
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [X] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
President and Chief Executive Officer
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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 Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
Amt. Of Issuer's Ownership Nature of
Securities Acquired (A) or Securities Benefically Form Indirect
Transaction Transaction Disposed of (D) Owned At End Direct (D) or Beneficial
Title of Security Date Code Amount (A) or (D) Price Of Issuer's Fiscal Year Indirect (I) Ownership
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<S> <C> <C> <C> <C> <C> <C>
Common Stock 1/24/00 J4(1) 2,580,645 A Indirect (I) By Link
Express
Delivery
Solutions (2)
Common Stock 2/7/00 J4(3) 1,500,000 A Indirect (I) By Genesis
Business
Alliance
Common Stock 4/6/00 J4(4) 500,000 D Indirect (I) By Genesis
Business
Alliance
Common Stock 4/9/00 S4 98,000 D 0.380 Indirect (I) By Genesis
Business
Alliance
Common Stock 6/6/00 C4 119,122 A 0.180 Indirect (I) By Genesis
Business
Alliance
Common Stock 6/8/00 S4 5,000 D 0.38 Indirect By Genesis
Business
Alliance
Common Stock 6/8/00 S4 5,000 D 0.38 Indirect By Genesis
Business
Alliance
Common Stock 6/8/00 S4 5,000 D 0.38 Indirect By Genesis
Business
Alliance
Common Stock 6/9/00 S4 5,000 D 0.37 Indirect By Genesis
Business
Alliance
Common Stock 6/9/00 S4 5,000 D 0.36 Indirect By Genesis
Business
Alliance
Common Stock 6/9/00 S4 5,000 D 0.36 Indirect By Genesis
Business
Alliance
Common Stock 6/9/00 S4 5,000 D 0.36 Indirect By Genesis
Business
Alliance
Common Stock 6/13/00 S4 10,000 D 0.59 Indirect By Genesis
Business
Alliance
Common Stock 6/13/00 S4 10,000 D 0.59 Indirect By Genesis
Business
Alliance
Common Stock 6/13/00 S4 10,000 D 0.50 Indirect By Genesis
Business
Alliance
Common Stock 6/14/00 S4 10,000 D 0.37 Indirect By Genesis
Business
Alliance
Common Stock 6/14/00 S4 12,000 D 0.37 Indirect By Genesis
Business
Alliance
Common Stock 6/16/00 C4 375,000 A 0.156 42,309,122 Indirect (I) By Genesis
Business
Alliance
Common Stock 6/19/00 S4 5,000 D 0.325 Indirect By Genesis
Business
Alliance
</TABLE>
(1) Shares received through issuer's purchase of 666,667 shares of Link
Express Delivery Solutions, Inc. in exchange for 2,580,645 shares of
etravelserve common stock. This transaction was rescinded on October 5,
2000 pursuant to specified contract provisions. See subsequent Form 4
filed on the date hereof.
(2) Reporting person is the sole officer and director of Link Express
Delivery Solutions, Inc., a Delaware corporation.
(3) Shares received by reporting person in consideration of past services
to issuer. Shares registered on February 1, 2000 Form S-8, valued at
$1.92/share.
(4) Shares issued to issuer's outside counsel, in lieu of cash, in
satisfaction of legal fees.
* 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.
(Print or Type Responses)
(Over)
(Form 5-07/99)
<PAGE>
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
9. 10.
Number Owner-
of ship
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- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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Stock Option Common
(right to buy) .25 5/22/00 A 916,500 5/22/03 5/22/00 Stock 916,500 I (1)
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Stock Option Common
(right to buy) .1797 6/06/00 A 600,000 6/6/03 6/6/00 Stock 600,000 I (1)
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Stock Option Common
(right to buy) .15625 6/16/00 A 375,000 6/16/03 6/16/00 Stock 375,000 1,397,378 I (1)
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</TABLE>
Explanation of Responses:
(1) Options were granted to Genesis Business Alliance, I*nc., owned 100% by
reporting person.
/s/ Paul R. Johnson 11/16/00
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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.
Page 2
<PAGE>
Derivative Securities Codes (Except For Transactions Exempt Pursuant to
Rule 16b-3)
C--Conversion of derivative security
E--Expiration of short derivative position
H--Expiration (or cancellation) of long derivative position with value
received
O--Exercise of out-of-the-money derivative security
X--Exercise of in-the-money or at-the-money derivative security
Other Section 16(b) Exempt Transaction and Small Acquisition Codes (Except
For Rule 16b-3 Codes Above)
G--Bona fide gift
L--Small acquisition under Rule 16a-6
W--Acquisition or disposition by will or the laws of descent and
distribution
Z--Deposit into or withdrawal from voting trust
Other Transaction Codes
J--Other acquisition or disposition (describe transaction)
K--Transaction in equity swap or instrument with similar characteristics
U--Disposition pursuant to a tender of shares in a change of control
transaction
To indicate that a holding should have been reported previously on Form 3,
place a "3" in Table I, column 3 or Table II, column 4, as appropriate. Indicate
in the space provided for explanation of responses the event triggering the Form
3 filing obligation. To indicate that a transaction should have been reported
previously on Form 4, place a "4" next to the transaction code reported in Table
I, column 3 or Table II, column 4 (e.g., an open market purchase of a
non-derivative security that should have been reported previously on Form 4
should be designated as "P4"). To indicate that a transaction should have been
reported on a previous Form 5, place a "5" in Table I, column 3 or Table II,
column 4, as appropriate. In addition, the appropriate box on the front page of
the form should be checked.
FORM 3 OR FORM 4 HOLDINGS OR TRANSACTIONS
NOT PREVIOUSLY REPORTED
To indicate that a holding should have been reported previously on a Form
3, place a "3" in Table I, column 3 or Table II, column 4, as appropriate.
Indicate in the space provided for explanation of responses the event triggering
the Form 3 filing obligation. To indicate that a transaction should have been
reported previously on Form 4, place a "4" next to the transaction code reported
in Table I, column 3 or Table II, column 4 (e.g., an open market purchase of a
non-derivative security that should have been reported previously on Form 4
should be designated as "P4"). In addition, the appropriate box on the front
page of the form should be checked.
