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U. S. SECURITIES AND EXCHANGE COMMISSION
FORM 5
[ ] Check box if no longer subject to Section 16.
Form 4 or Form 5 obligations may continue. Washington, D.C. 20549
See instruction 1(b).
[ ] Form 3 Holdings Reported. ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
[ ] Form 4 Transactions Reported.
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 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Reporting Person* Issuer (Check all applicable)
Universal Money Centers, Inc.
X Director X 10% Owner
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(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for X Officer ___ Other
Number of Reporting Month/Year --- (give title (specify
Bonsal, David S. Person (Voluntary) 1/31/99 below) below)
Chairman of the Board and
Chief Executive Officer
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(Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing
Original (Month/Year (Check applicable line)
X Form filed by One Reporting
6800 Squibb Road --- Person
___ Form filed by More than One
Reporting Person
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(City) (State) (Zip) Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned.
Shawnee Mission, KS 66202
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<S> <C> <C> <C> <C> <C> <C>
1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of
(Instr. 3) action action or Disposed of (D) Securities Form: Indirect
date: Code (Instr. 3, 4 and 5) Beneficially Direct Beneficial
(Month/ (Instr. 8) Owned at (D) or Ownership
Day/ End of Issuer's Indirect (Instr. 4)
Year) Fiscal Year. (I)
(Instr. 3 (Instr. 4)
and 4)
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Amount (A) or Price
(D)
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Common Stock 7/24/86 P 320,000 A $.1875
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Common Stock 8/6/86 P 123,527 A $.2461
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Common Stock 1/7/87 P 1,115,468 A $.3633
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Common Stock 2/9/90 P 130,000 A $.01
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* 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) Page 1 of 3
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U. S. SECURITIES AND EXCHANGE COMMISSION
FORM 5
[ ] Check box if no longer subject to Section 16.
Form 4 or Form 5 obligations may continue. Washington, D.C. 20549
See instruction 1(b).
[ ] Form 3 Holdings Reported. ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
[ ] Form 4 Transactions Reported.
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 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Reporting Person* Issuer (Check all applicable)
Universal Money Centers, Inc.
X Director X 10% Owner
- -------------------------------------------------------------------------------- --- ---
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for X Officer ___ Other
Number of Reporting Month/Year --- (give title (specify
Bonsal, David S. Person (Voluntary) 1/31/99 below) below)
Chairman of the Board and
Chief Executive Officer
- ------------------------------- ----------------------------------------------------------------------
(Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing
Original (Month/Year (Check applicable line)
X Form filed by One Reporting
6800 Squibb Road --- Person
___ Form filed by More than One
Reporting Person
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(City) (State) (Zip) Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned.
Shawnee Mission, KS 66202
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<S> <C> <C> <C> <C> <C> <C>
1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of
(Instr. 3) action action or Disposed of (D) Securities Form: Indirect
date: Code (Instr. 3, 4 and 5) Beneficially Direct Beneficial
(Month/ (Instr. 8) Owned at (D) or Ownership
Day/ End of Issuer's Indirect (Instr. 4)
Year) Fiscal Year. (I)
(Instr. 3 (Instr. 4)
and 4)
-------------------------
Amount (A) or Price
(D)
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Common Stock 5/7/90 P 133,815 A $.01
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Common Stock 1/4/95 P 1,000,000 A $.01
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Common Stock 12/20/95 P 1,601,340 A $.00747
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Common Stock 12/20/95 G 600,000 D
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Common Stock 4/29/96 P 8,600,000 A $.01 12,424,150 D
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* 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) Page 2 of 3
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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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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
1.Title of 2.Conver- 3.Trans- 4.Transac- 5.Number of 6.Date 7.Title 8.Price of 9.Number 10.Owner- 11.Nature
Derivative sion or action tion Code Derivative Exercisable and Amount Derivative of Deriv- ship of In-
Security Exercise Date (Instr. 8) Securities and of Security ative Form of direct
(Inst. 3) Price of (Month/ Acquired Expiration Underlying (Instr. 5) Securities Deriv- Bene-
Deriv- Day/ (A) or Date Securities Beneficial- ative ficial
ative Year) Disposed (Month/Day/ (Instr. 3 ly Owned at Security; Owner-
Security of (D) Year) and 4) End of Direct ship
(Instr.3, Month (D) or (Instr
4, and 5) (Instr. 4) Indirect 4)
(I)
(Instr. 4)
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(A) (D) Date Expira- Title Amount or
Exer- tion Date Number of
cisable Shares
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Explanation of Responses: Due to serious financial problems, the Issuer has not filed periodic reports with the Securities
and Exchange Commission (the "SEC") under the Securities Exchange Act of 1934, as amended (the "Exchange Act") since April
30, 1987. During this period, David S. Bonsal, a director and executive officer of the Issuer, did not file reports with the
SEC under Sections 13(d) and 16 of the Exchange Act. The Issuer and Mr. Bonsal are filing reports under the Exchange Act on this
date in order to bring their reports up-to-date.
/s/ David S. Bonsal April 26, 1999
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** David S. Bonsal 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 3 of 3
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