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OMB APPROVAL
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OMB Number 3235-0287
Expires: April 30, 1997
Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
[ ] Check this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person
FONG HENRY
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(Last) (First) (Middle)
7315 EAST PEAKVIEW AVENUE
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(Street)
ENGLEWOOD COLORADO 80111-6701
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
ROADMASTER INDUSTRIES, INC.
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3. IRS or Social Security Number of Reporting Person (Voluntary)
###-##-####
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4. Statement for Month/Year
JULY 1996
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ X ] Director [ ] 10% Owner
[ X ] Officer (give title below) [ ] Other (specify below)
President and Chief Executive Officer
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
COMMON STOCK, $.01 PAR VALUE 100 D
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COMMON STOCK, $.01 PAR VALUE -0- (1)
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
<PAGE>
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
WARRANT TO $1.48 11/2/92 11/2/97 COMMON 240, 240,000 D
PURCHASE COMMON STOCK 000
STOCK
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RESTRICTED COMMON COMMON 375, 375,000 D
STOCK GRANT(2) STOCK 000
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OPTION TO PURCHASE 12/7/94 12/7/04 COMMON 750, 750,000 D
COMMON STOCK(3) STOCK 000
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CONVERTIBLE -0- (1)
SUBORDINATED
DEBENTURES
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</TABLE>
Explanation of Responses:
(1) DOES NOT INCLUDE 5,105,437 SHARES OF COMMON STOCK AND 1,500 CONVERTIBLE
SUBORDINATED DEBENTURES OWNED BY EQUITEX, INC., A PUBLICLY-HELD BUSINESS
DEVELOPMENT COMPANY UNDER THE INVESTMENT COMPANY ACT OF 1940, AS AMEMDED.
REPORTING PERSON IS A DIRECTOR, OFFICER AND SIGNIFICANT SHAREHOLDER OF
EQUITEX BUT HAS NO PECUNIARY INTEREST IN THE SECURITIES OF THIS ISSUER
HELD BY EQUITEX.
(2) GRANT OF COMMON STOCK PURSUANT TO AN EMPLOYMENT AGREEMENT WHICH REQUIRES
REPORTING PERSON TO BE CONTINUOUSLY EMPLOYED BY THE ISSUER UNTIL 12/7/99,
AT WHICH TIME SECURITIES WILL BE ISSUED.
(3) VESTS 20 PERCENT PER YEAR BEGINNING DECEMBER 7, 1994.
/S/ HENRY FONG AUGUST 12, 1996
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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 procedures.
