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SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 10-C
REPORT BY ISSUER OF SECURITIES QUOTED ON NASDAQ
INTER-DEALER QUOTATION SYSTEM FILED PURSUANT TO
SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT
OF 1934 AND RULES 13A-17 AND 15D-17 THEREUNDER
US SERVIS, INC.
(Exact Name of Issuer as Specified in Charter)
414 Eagle Rock Avenue, West Orange, New Jersey 07052
(Address of Principal Executive Offices)
(201) 731-9252
(Issuer's Telephone Number, Including Area Code)
I. CHANGE IN NUMBER OF SHARES OUTSTANDING
Indicate any change (increase or decrease) of five percent or more in the
number of shares outstanding:
1. Title of security: Common Stock
2. Number of shares outstanding before the change: 6,296,137
3. Number of shares outstanding after the change: 6,296,137 (plus 2,088,000
shares of Common Stock of the registrant into which the Warrants and
shares of Series A Convertible Preferred Stock described below are
convertible)
4. Effective date of change: October 12, 1995
5. Method of change:
Specify method (such as merger, acquisition, exchange, distribution, stock
split, reverse split, acquisition of stock for treasury, etc.)
The Warrants and the Series A Convertible Preferred Stock, as described below,
were issued at the October 12, 1995 closing of the transactions contemplated by
that certain Series A Convertible Stock and Warrant Purchase Agreement by and
between the registrant and the purchasers named therein, after authorization by
the registrant's board of directors and stockholders.
Give brief description of transaction: At the annual meeting of stockholders
of the registrant held on October 10, 1995, the stockholders of the Company
voted to authorize the issuance of (i) Warrants to purchase 390,000 shares of
the registrant's Common Stock at an exercise price of $.10 per share, (ii)
Warrants to purchase 198,000 shares of the registrant's Common Stock at an
exercise price of $3.50 per share, and (iii) 1,500,000 shares of Series A
Convertible Preferred Stock, convertible into Common Stock of the registrant.
The Warrants and the Series A Convertible Preferred Stock were issued at the
October 12, 1995 closing of the transactions contemplated by that certain
Series A Convertible Stock and Warrant Purchase Agreement by and between the
registrant and the purchasers named therein.
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II. CHANGE IN NAME OF ISSUER
1. Name prior to change: MICRO Healthsystems, Inc.
2. Name after change: US SerVis, Inc.
3. Effective date of charter amendment changing name: October 11, 1995
4. Date of shareholder approval of change, if required: October 10, 1995
Date: October 16, 1995 /s/ Michael B. Loscalzo
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Michael B. Loscalzo, Vice President
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