4 1 d26762_form4.txt ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0287 Expires: December 31, 2001 Estimated average burden hours per response ....... .05 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [_] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* Grossman Richard -------------------------------------------------------------------------------- (Last) (First) (Middle) 259 Oakford Street -------------------------------------------------------------------------------- (Street) West Hempstead New York 11552 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Medjet Inc. (MDJT) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year 8/01 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 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 I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================

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 4(b)(v). 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) SEC 1474(3-99) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================

Explanation of Responses: (1) The reported securities are included within Medjet Units with a price of $125 per Unit. Each Unit consists of a) one share of Series B Convertible Preferred Stock, convertible into one hundred shares of Common Stock, and b) one hundred warrants, each exercisable to purchase one share of Common Stock. (2) Securities owned solely by Richard and Ana Grossman JTWROS, who are members of a "group" with Orin Hirschman for purposes of Section 13(d) of the Exchange Act. (3) Securities owned solely by Orin Hirschman. (4) Securities owned solely by Adam Smith Investment Partners, L.P. (5) Securities owned solely by Adam Smith Investments, Ltd. (6) Securities owned solely by Adam Smith & Company, Inc. (7) The reporting persons disclaim beneficial ownership of these securities except to the extent of their pecuniary interest therein. /s/ Richard Grossman 9/6/01 ------------------------------- ----------- **Signature of Reporting Person 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. 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. Joint Filer Information Name: Orin Hirschman Address: 1231 East 10th Street Brooklyn, New York 11230 Designated Filer: Richard Grossman Issuer and Ticker Symbol: Medjet Inc. (MDJT) Date of Event Reporting Statement: 8/17/01 Signature: /s/ Orin Hirschman -------------------------- Name: Ana Grossman Address: 259 Oakford Street West Hempstead, New York 11552 Designated Filer: Richard Grossman Issuer and Ticker Symbol: Medjet Inc. (MDJT) Date of Event Reporting Statement: 8/17/01 Signature: /s/ Ana Grossman -------------------------

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