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OMB APPROVAL
FORM 3 OMB Number..3235-0104
Expires:December 31, 2001
Estimated average burden
hours per response 0.5
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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
1. Name and Address of Reporting Person
Triad Petroleum, LLC
c/o Salmonson Christopher R.
1700 North Dixie Highway
Boca Raton Florida 33432
2. Date of Event Requiring Statement (Month/Day/Year)
09/14/00
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Issuer Name and Ticker or Trading Symbol
Regenesis Holdings, Inc. "RGNS"
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
( ) Director (X) 10% Owner ( ) Officer (give title below) ( ) Other
(specify below)
6. If Amendment, Date of Original (Month/Day/Year)
7. Individual or Joint/Group Filing (Check Applicable Line)
( ) Form filed by One Reporting Person
(X) Form filed by More than One Reporting Person
<TABLE>
<CAPTION>
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Table I -- Non-Derivative Securities Beneficially Owned |
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1. Title of Security |2. Amount of |3. Ownership |4. Nature of Indirect |
| Securities | Form: | Beneficial Ownership |
| Beneficially | Direct(D) or | |
| Owned | Indirect(I) | |
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<S> <C> <C> <C>
Common Stock, par value $.01 |96% of voting equity | I | Held through Triad Petroluem, LLC, in which
(1) the Reporting Person beneficially owns a 50%
interest.
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*If form is filed by more than one reporting person, see Instruction 5(b)(v). (over)
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. SEC 1473 (7-96)
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
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Table II -- Derivative Securitites Beneficially Owned |
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1.Title of Derivative |2.Date Exer- |3.Title and Amount | |4. Conver-|5. Owner- |6. Nature of Indirect |
Security | cisable and | of Underlying | |sion or |ship | Beneficial Ownership |
| Expiration | Securities | |exercise |Form of | |
| Date(Month/ |-----------------------|---------|price of |Deriv- | |
| Day/Year) | |Amount |deri- |ative | |
| Date | Expira- | |or |vative |Security: | |
| Exer- | tion | Title |Number of|Security |Direct(D) or | |
| cisable | Date | |Shares | |Indirect(I) | |
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<S> <C> <C> <C> <C> <C> <C> <C>
| | | | | | | |
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Series D Perferred Stock| | | Common Stock, par | (1) | (1) | I | Held through Triad |
par value $.01 value $.01 Petroleum, LLC, in which
the Reporting Person
owns a 50% interest
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Warrants to purchase | | | Common Stock, par | 750,000 | $.10 | D | |
Common Stock (3) value $.01
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</TABLE>
/s/ Triad Petroleum, LLC
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Triad Petroleum, LLC
By: Chris R. Slamonson
September 25, 2000
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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.
<PAGE>
(1) Pursuant to a Share Sale and Contribution Agreement (the "Agreement") dated
as of September 14, 2000, Triad Petroleum, LLC ("Triad") has a contractual
right to acquire 96% of the voting equity of the Regenesis Holdings, Inc.
through the sale of a combination of the Company's Common and convertible
Preferred Stock. As the capital structure of the Company prior to the
closing of the Triad transaction is subject to change, the precise number
of shares of common and preferred stock that are anticipated to be issued
to Triad are at present unknown.
(2) Reference is made to the statement on Schedule 13D, filed on the date
hereof, in respect of the Common Stock, as it may be amended from time to
time. Triad is jointly filing this Form 3 with Chris R. Salmonson,
FuelAmerica, LLC, a Florida limited liability company ("Fuel America"),
Robert L. Simmons and Rapture Holdings, Inc., a Florida corporation
(collectively, the "Group Filers"). Mr. Salmonson is an officer of Triad
and, jointly with his wife, is the sole owner of FuelAmerica, which itself
owns 50% of the membership interests in Triad. Mr. Simmons owns, as sole
shareholder of Rapture Holdings, Inc., the remaining 50% of the interests
in Triad not held by Mr. Salmonson through FuelAmerica. The Group Filers
each disclaim beneficial interest in the Common Stock held by another
except to the extent that a member of the Group Filers has a "pecuniary
interest" in such Common Stock. Mr. Salmonson disclaims beneficial
ownership of his wife's interest in the Common Stock to the extent of her
pecuniary interest therein.
(3) In connection with the Triad transaction, Triad was issued warrants to
purchase 750,000 shares of the Company's Common Stock at an exersise price
of $.10 per share of Common Stock as compensation for any amounts Triad
expended on behalf of the Company in connection with the proposed
transaction. Such warrants are only exercisable if the Triad transaction is
not consummated, and, if exercised, would represent less than 10% of the
Company's outstanding Common Stock.
<PAGE>
Joint Filer Information
Name: Triad Petroleum
Address: c/o Triad Petroleum, LLC
700 North Dixie Highway
Boca Raton, Florida 33432
Designated Filer: Triad Petroleum, LLC
Issuer & Ticker Symbol: Regenesis Holdings, Inc. (RGNS)
Date of Event
Requiring Statement: September 14, 2000
Signature: /s/ Triad Petroleum
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By: Chris Salmonson
Name: FuelAmerica, LLC
Address: Chris R. Salmonson
c/o Triad Petroleum, LLC
700 North Dixie Highway
Boca Raton, Florida 33432
Designated Filer: Triad Petroleum, LLC
Issuer & Ticker Symbol: Regenesis Holdings, Inc. (RGNS)
Date of Event
Requiring Statement: September 14, 2000
Signature: /s/ FuelAmerica, LLC
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By: Chris R. Salmonson
Name: Chris R. Salmonson
Address: c/o Triad Petroleum, LLC
700 North Dixie Highway
Boca Raton, Florida 33432
Designated Filer: Triad Petroleum, LLC
Issuer & Ticker Symbol: Regenesis Holdings, Inc. (RGNS)
Date of Event
Requiring Statement: September 14, 2000
Signature: /s/ Chris R. Salmonson
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By: Chris R. Salmonson
Name: Robert L. Simmons
Address: c/o Triad Petroleum, LLC
700 North Dixie Highway
Boca Raton, Florida 33432
Designated Filer: Triad Petroleum, LLC
Issuer & Ticker Symbol: Regenesis Holdings, Inc. (RGNS)
Date of Event
Requiring Statement: September 14, 2000
Signature: /s/ Robert L. Simmons
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By: Robert L. Simmons
Name: Rapture Holdings, Inc.
Address: c/o Triad Petroleum, LLC
700 North Dixie Highway
Boca Raton, Florida 33432
Designated Filer: Triad Petroleum, LLC
Issuer & Ticker Symbol: Regenesis Holdings, Inc. (RGNS)
Date of Event
Requiring Statement: September 14, 2000
Signature: /s/ Rapture Holdings, Inc.
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By: Robert L. Simmons
