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FORM 5 OMB Approval
U.S. SECURITIES AND EXCHANGE COMMISSION --------------------------
[ ] Check this box if no longer WASHINGTON, D.C. 20549 OMB Number 3235-0362
subject to Section 16. Form Expires: September 30,1998
4 or Form 5 obligations may ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden
continue. See Instruction 1(b). hours per response.....1.0
[ ] Form 3 Holdings Reported Filed pursuant to Section 16(a) of the Securities
[ ] Form 4 Transactions Reported and 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 | 2. Issuer Name and Ticker or Trading Symbol | 6. Relationship of Reporting Person
| | to Issuer (Check all applicable)
Hrobsky John Thomas | Zaxis International - ZAXS | _____ Director _____ 10% Owner
------------------------------------------------------------------------------------------| __X__ Officer (give title below)
(Last) (First) (Middle) | 3. IRS or Social | 4. Statement for | _____ Other (specify below)
| Security Number | Month/Year | President
| of Reporting | 2000 |-----------------------------------------
1105 Fireside Trail | Person (Voluntary) |------------------------| 7. Individual or Joint/Group Reporting
----------------------------------------| | 5. If Amendment, Date | (check applicable line)
(Street) | |of Original (Month/Year)| _X_ Form filed by One Reporting Person
| | | ___ Form filed by more than one
Broadview Heights, OH 44147 | ###-##-#### | | Reporting Person
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(City) (State) (Zip) | Table I - Non Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1. Title of Security | 2.Transaction | 3.Transaction | 4.Securities Acquired (A)| 5.Amount of | 6.Owner-| 7.Nature
(Instr. 3) | Date | Code | or Disposed of (D) | Securities | ship | of
| (Month/Day/ | (Instr. 8) | (Instr. 3, 4, and 5) | Beneficially| Form: | Indirect
| Year) | | | Owned at End| Direct | Bene-
| | -----------------------------------------| of Issuer's | (D) or | ficial
| | | Amount | (A) | Price | Fiscal Year | Indirect| Owner-
| | | | or | | (Instr. 3 | (I) | ship
| | | | (D) | | and 4) |(Instr.4)|(Instr.4)
---------------------------------------|---------------|---------------|--------|------|----------|-------------|---------|---------
| | | | | | | |
---------------------------------------|---------------|---------------|--------|------|----------|-------------|---------|---------
Common Stock | 12/16/99 | P |25,000 | A | $1.00 | 25,000 | D |
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* If the form is filed by more than one reporting person, see instruction 4(b)(v) (Over)
Form 5
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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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1.Title of Derivative Security | 2.Conversion | 3.Transaction | 4.Transaction | 5.Number of | 6.Date Exer- | 7.Title and Amount
(Instr. 3) | or Exercise | Date | Code | Derivative | cisable and | of Underlying
| Price of | | (Instr. 8) | Securities | Expiration Date | Securities
| Derivative | (Month/Day/ | | Acquired (A) | (Month/Day/Year) | (Instr. 3 and 4)
| Security | Year) | | or Disposed | |
| | | | of (D) |--------------------------------------
| | | | (Instr. 3, | Date | Expir- | | Amount or
| | | | 4, and 5) | Exer- | ation | Title | Number of
| | | |--------------| cisable | Date | | Shares
| | | | (A) | (D) | | | |
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Stock Options | $1.125 | 12/11/00 | A | |100,000 | 12/11/00|12/17/05| |
-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
Stock Options | $0.19 | 12/17/00 | A | |100,000 | 12/17/00|12/17/05| |
-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
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-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
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-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
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-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
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-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
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-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
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-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
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-------------------------------|--------------|---------------|-------|-------|------|-------|---------|--------|--------|----------
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8.Price of | 9.Number of | 10.Ownership | 11.Nature of |
Derivative | Derivative | Form of | Indirect |
Security | Securities | Derivative | Beneficial |
(Instr. 5) | Beneficially | Security; | Ownership |
| Owned at End | Direct (D) or | (Instr. 4) |
| of Year | Indirect (I) | |
| (Instr. 4) | (Instr. 4) | |
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| | | |
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| 25,000 | D | |
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Explanation of Responses:
/s/ John Hrobsky 1/8/01
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*Signature of Reporting Person 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.
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. Form 5
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