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FORM 3
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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 |2. Date of Event Re- |4. Issuer Name and Ticker or Trading Symbol |
| Reporting Person | quiring Statement | |
| | (Month/Day/Year) | |
| Blankenship, Jr. Clyde A. | 12/16/97 | TRIAD Medical Inc. (Nasdaq ticker symbol "TRMD") |
| ---------------------------------- | ----------------- | ------------------------------------------------------------------|
| (Last) (First) (Middle) |3. IRS or Social Se- |5. Relationship of Reporting Person to Issuer |6. If Amendment, |
| | curity Number of | (Check all applicable) | Date of Original |
| | Reporting Person | | (Month/Day/Year) |
| 5911 Greenwood Parkway | (Voluntary) | [X] Director [ ] 10% Owner | |
| ---------------------------------- | | | |
| (Street) | | | |
| | | [X] Officer (give title [ ] Other (specify| |
| | ---------------- | below) below) | |
| Bessemer Alabama 35023 | | | |
| ----------------------------------- | | Executive Vice President | |
| (City) (State) (Zip) | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| |------------------------------------------------------------------------------------------|
| | |
| | Table I -- Non-Derivative Securities Beneficially Owned |
|---------------------------------------|------------------------------------------------------------------------------------------|
|1. Title of Security |2. Amount of Securities | 3. Ownership | 4. Nature of Indirect Beneficial |
| (Instr. 4) | Beneficially Owned | Form: Direct (D) | Ownership |
| | (Instr. 4) | or Indirect (I) | (Instr. 5) |
| | | (Instr. 5) | |
|---------------------------------------|--------------------------------|----------------------|----------------------------------|
| Common Stock | 334,799 | D | |
|---------------------------------------|--------------------------------|----------------------|----------------------------------|
| | | | |
|---------------------------------------|--------------------------------|----------------------|----------------------------------|
| | | | |
|---------------------------------------|--------------------------------|----------------------|----------------------------------|
| | | | |
|---------------------------------------|--------------------------------|----------------------|----------------------------------|
| | | | |
|---------------------------------------|--------------------------------|----------------------|----------------------------------|
| | | | |
|---------------------------------------|--------------------------------|----------------------|----------------------------------|
| | | | |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
(Print or Type Responses)
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FORM 3 (Continued)
Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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|1. Title of Derivative |2. Date Exer- |3. Title and Amount of |4. Conver- |5. Ownership |6. Nature of In- |
| Security (Instr. 4) | cisable and | Securities Underlying | sion or | Form of | direct Beneficial|
| | Expiration | Derivative Security | Exercise| Derivative | Ownership |
| | Date | (Instr. 4) | Price of| Security: | (Instr. 5) |
| | (Month/Day/ | | Deri- | Direct (D) | |
| | Year) | | vative | or Indirect| |
| | | | Security| (I) | |
| |-----------------|--------------------------------| | (Instr. 5) | |
| | | | | Amount | | | |
| |Date |Expira- | | or | | | |
| |Exer- |tion | Title | Number | | | |
| |cisable |Date | | of | | | |
| | | | | Shares | | | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
|Options |6/98 (1)| 12/07 | Common Stock | 5,000 | 8.00 | D | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
| | | | | | | | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
| | | | | | | | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
| | | | | | | | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
| | | | | | | | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
| | | | | | | | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
| | | | | | | | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
| | | | | | | | |
|-------------------------------|--------|--------|--------------------|-----------|-----------|--------------|--------------------|
| | | | | | | | |
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Explanation of Responses:
(1) Options become exercisable as to 25% of such shares six months after the
pricing date of the registration statement relating to the Company's initial
public offering and as to 25% of such shares on each anniversary of that date.
/s/ Clyde A. Blankenship, Jr. 12/9/97
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**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.
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