4 1 g4-30377e.txt 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB Approval FORM 4 WASHINGTON, D.C. 20549 ------------------ |_| Check this box if no OMB Number 3235-0287 longer subject to Expires: December 31, 2001 Section 16. Form 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden or Form 5 Hours per response....0.5 obligations may continue Instruction 1(b). 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 (Print or Type Responses) -------------------------------------------- ----------------------------------------------- --------------------------------------- 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Crist E. Scott Billserv, Inc. BLLS X Director 10% Owner -------------------------------------------- ----------------------------------------------- --- --- (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for Officer (give Other (specify Number of Reporting Month/Year --- title below) --- below) Person (Voluntary) 211 N. Loop 1604 East, Suite 100 December 2002 -------------------------------------------- ------------------- --------------------------------------- (Street) 5. If Amendment, 7. Individual or Joint/Group Filing Date of Original (Check Applicable Line) (Month/Year) X Form filed by One Reporting Person --- Form filed by More than One San Antonio TX 78232 ---Reporting Person ----------------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ---------------------------------------------------------------------------------------------------------------------------------- 1.Title of Security 2.Trans- 3.Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7.Nature of (Instr. 3) action action or Disposed of (D) Securities ship Indirect Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial (Instr. 8) Owned at Direct Owner- End of Month (D) or ship (Month/ ------------------------------------- (Instr. 3 and Indirect (Instr. 4) Day/ Code V Amount (A)or Price 4) (I) Year) (D) (Instr.4) ------------------------------------------------------------------------------------------------------------------------------------ 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 4(b)(v). SEC 1474 (7-96) FORM 4 (CONTINUED) TABLE II-- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------ ---------- -------- --------- ------------- ---------------- -------------- -------- --------- ---------- ------------- 1.Title of 2.Conver- 3.Trans- 4.Trans- 5.Number of 6.Date Exer- 7.Title and 8.Price 9.Number 10.Owner- 11.Nature Derivative sion action action Derivative cisable and Amount of of of ship of Security or Date Code Securities Expiration Underlying Deriv- Deriv- Form Indirect Instr. 3) Exercise (Instr. Acquired Date Securities Ative ative of Beneficial Price of (Month/ 8) (A)or (Month/Day/ (Instr. 3 Secur- Secur- Deriv- Ownership Deri- Day/ Disposed of Year) and 4) ity ities ative (Instr.4) vative Year) (D)(Instr. (Instr Bene- Security: Security 3, 4 and 5) 5) ficially Direct Owned (D) or ----- --- ------- ----- ------- -------- ------ ------- at End Indirect Code V (A) (D) Date Expira- Title Amount of (I) Exer- tion or Month (Instr. cisable Date Number (Instr. 4) of 4) Shares ------------ ---------- -------- ----- --- ------- ----- ------- -------- ------ ------- -------- --------- ---------- ------------- Stock Option $0.18 12/31/02 A 100,000 (1) 12/31/12 Common 100,000 $0.18 D ------------ ---------- -------- ----- --- ------- ----- ------- -------- ------ ------- -------- --------- ---------- ------------- Stock Option $0.26 12/13/02 A 35,000 (2) 12/13/12 Common 35,000 $0.26 265,000 D ------------ ---------- -------- ----- --- ------- ----- ------- -------- ------ ------- -------- --------- ---------- ------------- Explanation of Responses: (1) 1/3 on 12/31/03, 12/31/04 and 12/31/05 -------------------------------------------------------------------- (2) 1/3 on 6/13/03, 12/13/03 and 6/13/04 (cancellation and re-grant) -------------------------------------------------------------------- /s/ 1/22/2003 **Intentional misstatements or omissions of facts constitute ----------------------------- ------------------ Federal Criminal Violations. **Signature of Reporting Person Date 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 is insufficient, see Instruction 6 for procedure. Page 2 SEC 1474 (7-96)