U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3/A
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
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1. Name and Address of Reporting Person*
Fugler Michael Roy
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(Last) (First) (Middle)
5805 Sepulveda Blvd. 4th Floor
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(Street)
Van Nuys CA 91411
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
12/09/99
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
GenesisIntermedia.com, Inc. GENI
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[ ] Officer (give title below) [_] Other (specify below)
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6. If Amendment, Date of Original (Month/Day/Year)
07/10/00
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form Filed by One Reporting Person
[_] Form Filed by More than One Reporting Person
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Table I -- Non-Derivative Securities Beneficially Owned
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3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial
(Instr. 4) (Instr. 4) (Instr. 5) Ownership (Instr. 5)
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Common Stock 2,500(1) D
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v).
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Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of 2. Date Exercisable 3. Title and Amount 4. Conversion 5. Ownership Form 6. Nature of
Derivative and Expiration Date Underlying Derivative or Exercise of Derivative Indirect
Security (Month/Day/Year) Seucirty (Instr.4) Price of Security: Direct Beneficial
(Instr.4) ------------------------ -------------------------- Derivative (D) or Indirect (I) Ownership
Date Expiration Amount or Number Security (Instr. 5) (Instr. 5)
Excercisable Date Title of Shares
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Warrant 6/14/99 6/14/04 Common Stock 16,000(1) $14.025 D
(Underwriter
warrant)
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Explanation of Responses:
(1) Number of shares do not reflect the 3-for-1 stock split which was effected
on March 21, 2001.
This amendment is being filed to reflect shares owned at the date of the event
requiring this statement which were inadvertenty omitted from the original
filing.
June 11, 2001 /s/ Michael Roy Fugler
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Date **Signature of Reporting Person
**International 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.
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