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- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION -----------------------------
FORM 3 WASHINGTON, D.C. 20549 OMB APPROVAL
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INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES OMB Number: 3235-0104
Expires: December 31, 2001
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Estimated average burden
Section 17(a) of the Public Utility Holding Company Act of 1935 or hours per response .... 0.5
(Print or Type Responses) Section 30(f) of the Investment Company Act of 1940 -----------------------------
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1. Name and Address of Reporting Person* 2. Date of Event Re- 4. Issuer Name AND Ticker or Trading Symbol
quiring Statement
Queen Jeffrey (Month/Day/Year) Response USA, Inc. ("RSPN")
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(Last) (First) (Middle) 1/11/00 5. Relationship of Reporting Person(s) 6.If Amendment, Date
----------------------- to Issuer (Check all applicable) of Original
3. IRS or Social Se- Director X 10% Owner (Month/Day/Year)
curity Number of ---- ----
777 Yamato Road, Suite 350 Reporting Person Officer (give Other (specify ---------------------
- ------------------------------------------------- (Voluntary) X title below) below) 7. Individual or
(Street) ---- ---- Joint/Group Filing
(Check Applicable
President Line)
--------------------------- Form filed by One
X Reporting Person
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Form filed by
More than One
Reporting Person
Boca Raton FL 33431 ---
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(City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial
(Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5)
(Instr. 4) (D) or Indirect
(I) (Instr. 5)
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Common Stock, $0.008 par value per share 409,323 D
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Same 241,518 (1) I By Trust
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Same 66,378.44 (2) I By Zenex Jl, L.L.C.
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Same 368.56 (3) I By Zenex Al, L.L.C.
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
* If the form is filed by more than one reporting person, SEE Instruction 5(b)(v). SEC 1473 (7-97)
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 CONTROL NUMBER.
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FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE
SECURITIES)
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1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial
Expiration (Instr. 4) Exercise Form of Ownership
Date Price of Deriv- (Instr. 5)
(Month/Day/ Deri- ative
Year) vative Security:
-------------------------------------------------- Security Direct
Amount (D) or
Date Expir- or Indirect
Exer- ation Title Number (I)
cisable Date of
Shares (Instr. 5)
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Explanation of Responses:
(1) Held directly by the Jeffrey Queen and Andrew Queen Irrevocable Trust U/A January 2, 1998. The Reporting Person's children
are beneficiaries of this Trust.
(2) Held directly by Zenex Jl, L.L.C., of which the Reporting Person is a member.
(3) Held directly by Zenex Al, L.L.C., of which the Reporting Person is a member.
/s/ Jeffrey Queen 1/27/00
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**Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date
Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Jeffrey Queen
Note: File three copies of this Form, one of which must be manually signed. If space 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. Page 2
SEC 1473 (7-97)
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