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OMB APPROVAL
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OMB Number: 3235-0287
+--------+ Expires: September 30, 1998
| FORM 4 | Estimated average burden
+--------+ hours per response ....... 0.5
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U.S. 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
[X] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
1.Name and Address of Reporting Person
QC Optics Voting Trust
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(Last) (First) (Middle)
46 Jonspin Road
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(Street)
Wilmington MA 01887
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(City) (State) (Zip)
2.Issuer Name and Ticker or Trading Symbol QC Optics, Inc. ("OPC")
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3.IRS or Social Security Number of Reporting Person (Voluntary)
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4.Date of Event Requiring Statement (Month/Year) 02/00
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5.If Amendment, Date of Original (Month/Day/Year)
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6.Relationship of Reporting Person to Issuer (Check all applicable)
[ ] Director [ ] Officer [X] 10% Owner [ ] Other
(give title below) (specify below)
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7.Individul 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>
<CAPTION>
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TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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<S> <C> <C> <C> <C> <C> <C>
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Month Direct Benefi-
(Month/ (Instr. 3 and 4) (D) or cial
Day/ --------------------------------------- Indirect Owner-
Year) Code V Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
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Common Stock, $.01 par 2/28/00 J 314,754 D 1,032,859 D See
value per share Note 1
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 1 of 2
* If the form is filed by more than one reporting person, see Instruction 4(b)(v). SEC 1474 (7-96)
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C> <C> <C>
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
-------------------------- Exer- tion Title Number of
Code V (A) (D) cisable Date Shares
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None
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<C> <C> <C>
9. Number of 10. Ownership 11. Nature of
Derivative Form of Indirect
Securities Derivative Beneficial
Beneficially Security: Ownership
Owned at End Direct (D) (Instr. 4)
of Month or Indirect (I)
(Instr. 4) (Instr. 4)
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</TABLE>
Explanation of Responses:
1. Pursuant to the terms of a settlement agreement, the 314,754 shares of common
stock beneficially owned by K. Andrew Bernal have been transferred to QC Optics,
Inc. Eric T. Chase is the sole voting trustee of the QC Optics Voting Trust. The
stockholders participating in the Voting Trust and the number of their shares
subject to the Voting Trust are as follows: Eric T. Chase - 634,517; Jay L.
Ormsby - 162,599; John R. Freeman - 78,581; Albert E. Tobey - 78,581; Abdu
Boudour - 78,581.
QC Optics Voting Trust
By: /s/ Eric T. Chase 3/9/00
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**Signature of Reporting Person Date
Eric T. Chase, Trustee
**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 is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained
in this form are not Page 2 required to respond unless the form displays a
currently valid OMB Number. SEC 1474 (7-96)
