SC 13G 1 billserv-evans_52712.txt SC-13G FOR ROBERT EVANS UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. )* Billserv, Inc. -------------------------------------------------------------------------------- (Name of Issuer) Common Stock, $.001 par value per share -------------------------------------------------------------------------------- (Title of Class of Securities) 090181108 -------------------------------------------------------------------------------- (CUSIP Number) November 28, 2001 -------------------------------------------------------------------------------- (Date of Event Which Requires Filing of this Statement) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: [ ] Rule 13d-1(b) [X] Rule 13d-1(c) [ ] Rule 13d-1(d) *The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page. The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). Page 2 of 6 Schedule 13G CUSIP NO. 090181108 -------------------------------------------------------------------------------- 1. Names of Reporting Persons I.R.S. Identification Nos. of above persons (entities only) Robert Evans -------------------------------------------------------------------------------- 2. Check the Appropriate Box if a Member of a Group (See Instructions) (a) ----------------- (b) ----------------- -------------------------------------------------------------------------------- 3. SEC USE ONLY -------------------------------------------------------------------------------- 4. Citizenship or Place of Organization Illinois, USA -------------------------------------------------------------------------------- Number of 5. Sole Voting Power Shares 1,867,700 Beneficially ----------------------------------------------------------- Owned by 6. Shared Voting Power Each 0 Reporting ----------------------------------------------------------- Person With 7. Sole Dispositive Power 1,867,700 ----------------------------------------------------------- 8. Shared Dispositive Power 0 -------------------------------------------------------------------------------- 9. Aggregate Amount Beneficially Owned by Each Reporting Person 1,867,700 -------------------------------------------------------------------------------- 10. Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) [ ] -------------------------------------------------------------------------------- 11. Percent of Class Represented by Amount in Row (9) 8.9% -------------------------------------------------------------------------------- 12. Type of Reporting Person (See Instructions) IN -------------------------------------------------------------------------------- Page 3 of 6 Schedule 13G CUSIP NO. 090181108 ITEM 1. (A) NAME OF ISSUER: Billserv, Inc. (B) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: 211 North Loop 1604 East, Suite 100 San Antonio, TX 78232 ITEM 2. (A) NAME OF PERSON FILING: Robert Evans (B) ADDRESS OF PRINCIPAL BUSINESS OFFICE, IF NONE, RESIDENCE: P.O. Box 56 Williamsville, IL 68693 (C) CITIZENSHIP: Illinois, USA (D) TITLE OF CLASS OF SECURITIES: Common Stock, $.001 par value per share (E) CUSIP NUMBER: 090181108 ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO [SECTIONS] 240.13D-1(B) OR 240.13D-2(B) OR (C), CHECK WHETHER THE PERSON FILING IS A: (a) [ ] Broker or dealer registered under Section 15 of the Act (15 U.S.C. 78o). (b) [ ] Bank as defined in Section 3(a)(6) of the Act (15 U.S.C. 78c). (c) [ ] Insurance company as defined in Section 3(a)(19) of the Act (15 U.S.C. 78c). (d) [ ] Investment company registered under Section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8). (e) [ ] An investment adviser in accordance with [section] 240.13d-1(b)(1)(ii)(E). (f) [ ] An employee benefit plan or endowment fund in accordance with [section] 240.13d-(b)(1)(ii)(F). Page 4 of 6 Schedule 13G CUSIP NO. 090181108 (g) [ ] A parent holding company or control person in accordance with [section] 240.13d-1(b)(1)(ii)(G). (h) [ ] A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813). (i) [ ] A church plan that is excluded from the definition of an investment company under Section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3). (j) [ ] Group, in accordance with [section] 240.13d-(b)(1)(ii)(J). Not applicable. ITEM 4. OWNERSHIP (A) AMOUNT BENEFICIALLY OWNED: 1,867,700* (B) PERCENT OF CLASS: 8.9%* (C) NUMBER OF SHARES AS TO WHICH THE PERSON HAS: I. SOLE POWER TO VOTE OR TO DIRECT THE VOTE: 1,867,700* II. SHARED POWER TO VOTE OR TO DIRECT THE VOTE: 0 III. SOLE POWER TO DISPOSE OR TO DIRECT THE DISPOSITION OF: 1,867,700* IV. SHARED POWER TO DISPOSE OR TO DIRECT THE DISPOSITION OF: 0 ---------------- *Includes warrants to purchase 480,000 shares of Common Stock. ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following. [ ] Page 5 of 6 Schedule 13G CUSIP NO. 090181108 ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON Not applicable. ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY OR CONTROL PERSON Not applicable. ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBER OF THE GROUP Not applicable. ITEM 9. NOTICE OF DISSOLUTION OF GROUP Not applicable. ITEM 10. CERTIFICATION By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect. Page 6 of 6 Schedule 13G CUSIP NO. 090181108 SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. Date: December 5, 2001 By: /s/ Robert Evans ----------------------------------- -------------------------------- Robert Evans