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*
Heyworth George W.
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(Last) (First) (Middle)
13063 Ventura Boulevard
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(Street)
Studio City California 91604-2238
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
June, 1999
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
GenesisIntermedia.com, Inc., a Delaware corporation (Name)
Pacific Exchange: GNS
Nasdaq: GENI
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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6. If Amendment, Date of Original (Month/Day/Year)
Not applicable.
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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
<TABLE>
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Table I -- Non-Derivative Securities Beneficially Owned
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<S> <C> <C> <C> <C>
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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Not Applicable
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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.
Table II -- Derivative Securities Beneficially Owned (e.g., puts,
calls, warrants, options, convertible securities)
<TABLE>
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Table II -- Derivative Securities Beneficially Owned (e.g., puts,
calls, warrants, options, convertible securities)
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<S> <C> <C> <C> <C> <C>
1. Title of 2. Exercisable and 3. Title and Amount 4. Conversion 5. Ownership 6. Nature of
Derivative Expiration Date Underlying Derivative or Exercise Form of Indirect
Security (Month/Day/Year) Seucirty (Instr.4) Price of Derivative Beneficial
------------------------ ----------------------- Derivative Security: Direct Ownership
Date Amount or Number Security (D) or Indirect (I) (Instr. 5)
Excercisable Expiration Title of Shares (Instr. 5)
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Option granted 7/31/99 1/15/04 Common Stock, 12,500 $8.50 Direct N/A
under 1998 par value $.001
GenesisIntermedia.
com, Inc. Stock
Incentive Program
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Option granted 1/31/00 1/15/04 Common Stock, 12,500 $8.50 Direct N/A
under 1998 par value $.001
GenesisIntermedia.
com, Inc. Stock
Incentive Program
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Option granted 7/31/00 1/15/04 Common Stock, 12,500 $8.50 Direct N/A
under 1998 par value $.001
GenesisIntermedia.
com, Inc. Stock
Incentive Program
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Option granted 1/31/01 1/15/04 Common Stock, 12,500 $8.50 Direct N/A
under 1998 par value $.001
GenesisIntermedia.
com, Inc. Stock
Incentive Program
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</TABLE>
Explanation of Responses:
June 14, 1999 /s/ George W. Heyworth
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Date **Signature of Reporting Person
**International 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.
2
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