SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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SCHEDULE 13D
(Rule 13d-101)
INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT
TO RULE 13d-1(a) AND AMENDMENTS THERETO FILED PURSUANT TO
RULE 13d-2(a)
(Amendment No. 5)(1)
American Claims Evaluation, Inc.
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(Name of Issuer)
Common Stock, par value $.01 per share
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(Title of Class of Securities)
025144 10 6
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(CUSIP Number)
Mr. Gary Gelman
American Claims Evaluation, Inc.
One Jericho Plaza
Jericho, New York 11753
(516) 938-8000
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(Name, Address and Telephone Number of Person Authorized to Receive Notices and
Communications)
November 1, 2000
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(Date of Event which Requires Filing of this Statement)
If the filing person has previously filed a statement on Schedule 13G to
report the acquisition that is the subject of this Schedule 13D, and is filing
this schedule because of Rule 13d-1(e), 13d-1(f) or 13d-1(g), check the
following box |_| .
Note. Schedules filed in paper format shall include a signed
original and five copies of the schedule, including all exhibits. See Rule
13d-7(b) for other parties to whom copies are to be sent.
(Continued on following pages)
(Page 1 of 4 Pages)
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(1) The remainder of this cover page shall be filled out for a reporting
person's initial filing on this form with respect to the subject class of
securities, and for any subsequent amendment containing information which would
alter disclosures provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed
to be "filed" for the purpose of Section 18 of the Securities Exchange Act of
1934 ("Act") or otherwise subject to the liabilities of that section of the Act
but shall be subject to all other provisions of the Act (however, see the
Notes).
<PAGE>
CUSIP No. 025144 10 6 SCHEDULE 13D Page 2 of 4 Pages
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1 NAMES OF REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Gary Gelman
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2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) |_|
(b) |_|
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3 SEC USE ONLY
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4 SOURCE OF FUNDS*
n/a
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5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT
TO ITEM 2(d) or 2(e) |_|
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6 CITIZENSHIP OR PLACE OF ORGANIZATION
USA
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7 SOLE VOTING POWER
2,946,400
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NUMBER OF 8 SHARED VOTING POWER
SHARES
BENEFICIALLY 0
OWNED BY --------------------------------------------------------
EACH 9 SOLE DISPOSITIVE POWER
REPORTING
PERSON 2,946,400
WITH --------------------------------------------------------
10 SHARED DISPOSITIVE POWER
0
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11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
2,946,400
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12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES
CERTAIN SHARES* |_|
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13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
60%
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14 TYPE OF REPORTING PERSON*
IN
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*SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
Gary Gelman hereby amends and supplements the Schedule 13D
originally filed with the Securities and Exchange Commission (the "SEC") on
August 19, 1988 as amended by Amendment No.1 filed with the SEC on July 17,
1989, and as further amended by Amendment No. 2 filed with the SEC on November
1, 1991, by Amendment No. 3 filed with the SEC on July 26, 1993 and by Amendment
No. 4 filed with the SEC on July 8, 1997 (the "Schedule 13D").
This Schedule relates to the common stock, par value $.01 per share
(the "Shares"), of American Claims Evaluation, Inc., a New York corporation (the
"Company").
On November 1, 2000, Mr. Gelman was granted options to acquire
250,000 Shares at a price of $2.56 per Share, under the Company's 2000 Stock
Option Plan.
Item 5. Interest in Securities of the Issuer.
Item 5(a) of the Schedule is hereby amended by deleting the existing text
and inserting the following text in its stead:
Mr. Gelman beneficially owns (as defined by Rule 13d-3 under the
Securities Exchange Act of 1934, as amended) 2,946,400 Shares, or
60% of the Shares as of November 1, 2000. Of such Shares, 650,000
are issuable pursuant to grants under the Company's employee stock
option plans.
Item 5(b) of the Schedule is hereby amended by deleting the existing text
and inserting the following text in its stead:
Mr. Gelman has sole voting and dispositive power over 2,946,400
Shares.
Item 5(c) of the Schedule is hereby amended by deleting the existing text
and inserting the following text in its stead:
Except for the grant of options to purchase 250,000 Shares to Mr.
Gelman reported herein, no transactions in Shares were effected by Mr. Gelman
during the past sixty (60) days.
3
<PAGE>
Signature.
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
Date: November 6, 2000
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Gary Gelman
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