U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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
Baker Douglas
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(Last) (First) (Middle)
275 Commercial Blvd. Suite 260
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Ft. Lauderdale FL 33308
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
12/13/99
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name or Ticker or Trading Symbol
Health Express USA, Inc.
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5. 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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6. If Amendment, Date of Original (Month/Year)
N/A
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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 Beneficially Owned
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3. Ownership Form
2. Amount of Securities direct (D) or
1. Title of Security Beneficially Owned Indirect (I)
(Instr. 4) (Instr. 4) (Instr. 5)
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Common Stock 2,052,170 D
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
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Table II -- Derivative Securities Beneficially
Owned (e.g., puts, calls, warrants, options,
convertible securities)
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3. Title and Amount of Securities
Underlying Derivative Security
2. Date Exercisable (Instr. 4)
and Expiration Date ------------------------------
(Month/Day/Year) Amount
---------------------- or
Date Expira- Number
1. Title of Derivative Exer- tion of
Security (Instr. 4) cisable Date Title Shares
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Stock Option 6/15/99 6/15/09 Common Stock 1,903,000
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Explanation of Responses: The option was granted on June 15, 1999 and is
exercisable, in whole or in part at any time, at an exercise price of $.35 per
share for a period of ten years from the date of grant.
By: /s/ Douglas Baker December 21, 1999
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**Signature of Reporting Person Date
Intentional misstatements or omissions of facts constitute Federal
Criminal Violations. See 19 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.
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