<PAGE>
 
         (h) [ ]   Group, in accordance with (S)240.13d-1(b)(1)
                   (ii)(H)

Item 4   Ownership.                                                     
                                                                        
         (a) Amount Beneficially Owned:                                 
                BAC                                              254,000
                BANT&SA                                          254,000
                                                                        
         (b) Percent of Class:                                          
                BAC                                                  .8%
                BANT&SA                                              .8% 

         (c) Number of shares as to which such person has:  

               (i)   sole power to vote or direct the
                     vote:

                     BAC                                               0
                     BANT&SA                                     254,000

              (ii)   shared power to vote or direct the
                     vote: 

                     BAC                                               0
                     BANT&SA                                           0
 
             (iii)   sole power to dispose or direct the
                     disposition of:

                     BAC                                               0
                     BANT&SA                                           0

              (iv)   shared power to dispose or to direct
                     the disposition of:*

                     BAC                                         254,000
                     BANT&SA                                     254,000

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 [X].

Item 6   Ownership of More than Five                      Not Applicable
         Percent on Behalf of Another
         Person.

* The power to dispose or direct the disposition of shares is shared between the
  parent company and its subsidiaries.


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