---------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------- FORM 5 WASHINGTON, DC 20549 OMB APPROVAL ---------- ------------------------------- ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: [ ] Check box if no longer EXPIRES: subject to Section 16. Filed pursuant to Section 16(a) of the Securities ESTIMATED AVERAGE BURDEN Form 4 or Form 5 Exchange Act of 1934, Section 17(a) of the HOURS PER RESPONSE.........1.0 obligations may continue. Public Utility Holding Company Act of 1935 -------------------------------- See Instruction 1(b). or Section 30(f) of the [ ] Form 3 Holdings Reported Investment Company Act of 1940 [X] Form 4 Transactions Reported ------------------------------------------------------------------------------------------------------------------------------------ 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) Su Weixue Billserv, Inc. BLLS --------------------------------------------- ---------------------------------------------- Director 10% Owner (Last) (First) (Middle) 3. IRS Identification 4. Statement for --- --- Number of Reporting Month/Year 211 N. Loop 1604 East, Suite 100 Person, if an entity X Officer Other --------------------------------------------- (Voluntary) October 2001 --- (give title --- (Specify title (Street) ------------------- below) below) 5. If Amendment, VP, Information Technology San Antonio TX 78232 -------------------- Date of ------------------------------- --------------------------------------------- Original 7. Individual or Joint/Group Reporting (City) (State) (Zip) (Month/Year) (Check Applicable Line) X Form filed by One Reporting --- Person Form filed by more than --- One Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- 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. Ownership 7. Nature of (Instr. 3) action action or Disposed of (D) Securities Form: Indirect Date Code (Instr. 3, 4 and 5) Beneficially Direct (D) Beneficial (Instr. 8) Owned at End or Ownership (Month/ ----------------------- of Fiscal Year Indirect (I) (Instr. 4) Day/ (A) or (Instr. 3 and 4) (Instr. 4) Year) Amount (D) Price ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 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. (Over) *If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). SEC 2270 (7-97) FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Transaction 5. Number of 6. Date Exer- 7. Title and 8. Price of Security sion or action Code Derivative cisable and Amount of Derivative (Instr. 3) Exercise Date (Instr. 8) Securities Expiration Underlying Security Price of (Month/ Acquired (A) Date Securities (Instr. 5) Derivative Day/ or Disposed of (Month/Day/ (Instr. Security Year) (D) (Instr. 3, Year) 3 and 4) 4, and 5) ---------------- ----------------- Date Expira- Amount or ---------------- Exer- tion Number of (A) (D) cisable Date Title Shares ------------------------------------------------------------------------------------------------------------------------------------ Stock Option $.86 10/31/01 A4 30,000 (1) 10/31/11 Common 30,000 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------- 1. Title of Derivative 9. Number of 10. Ownership of 11. Nature of Security Derivative Derivative Indirect (Instr. 3) Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) -------------------------------------------------------------------------------------------------------- Stock Option 85,000 D -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) 10,000 shares on 10/31/02, 10/31/03, 10/31/04 **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). -------------------------- ----------------- **Signature of Date Reporting Person Note: File three copies of this Form, one of which must be manually signed. Page 2 If space provided is insufficient, see Instruction 6 for procedure. SEC 2270 (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 number.