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OMB APPROVAL
OMB Number: 3235-0104
Expires: September 30, 1998
Estimated average burden
hours per response...........0.5
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FORM 3
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 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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<S> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
Deptula-Hicks Darlene M. Statement Trading Symbol of Original
- ---------------------------------------- 6/23/99(1) IMPLANT SCIENCES CORPORATION (Month/Day/Year)
(Last) (First) (Middle) (IMPLU)(2)
c/o IMPLANT SCIENCES CORPORATION ---------------------------- ----------------------------------
107 AUDUBON ROAD, #5 3. IRS Identification 5. Relationship of Reporting -----------------------
- ---------------------------------------- Number of Reporting Person to Issuer 7. Individual or Joint/
(Street) Person, if an Entity (Check all applicable) Group Filing (Check
WAKEFIELD MASSACHUSETTS 01880 (Voluntary) Director 10% Owner applicable line)
- ---------------------------------------- ---------------------------- ----- ----- X Form filed by
(City) (State) (Zip) X Officer Other ----- One Reporting
----- (give ----- (specify Person
title below) below) Form filed by
VICE PRESIDENT AND CHIEF ----- More than One
FINANCIAL OFFICER Reporting Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 5)
(Instr. 5)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
*If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v). SEC 1473 (7-96)
(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)
<S> <C> <C> <C> <C> <C>
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deri- ative
vative Security:
Security Direct
------------------------------------------------- (D) or
Date Expira- Amount or Indirect
Exercis- tion Title Number (I)
able Date of Shares (Instr.
5)
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Stock Option (right to buy) (3) 7/13/08 Common Stock 25,200 $4.00 D
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Explanation of Responses:
(1) The date indicated is the effective date of the registration statement of
the Issuer filed pursuant to Sections 12(b) and 12(g) of the Securities
Exchange Act of 1934.
(2) This is the trading symbol of the Issuer's units (each unit consisting of
one share of common stock and one redeemable common stock purchase warrant)
on the Nasdaq SmallCap Market, Inc. The Company will apply for the common
stock and warrants to be separately listed on the Nasdaq SmallCap Market
under the trading symbols "IMPL" and "IMPLW", respectively. The units,
common stock and warrants are also separately listed on the Boston Stock
Exchange under the trading symbols "IMXU", "IMX" and "IMXW", respectively.
(3) Grant to reporting person of option to purchase 25,200 shares of common
stock under the Issuer's 1998 Incentive and Nonqualified Stock Option Plan.
The option becomes exercisable in 33% increments on July 1, 1999, July 1,
2000 and July 1, 2001, respectively.
/s/ Darlene M. Deptula-Hicks June 23, 1999
**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 Reporting Person Date
Darlene M. Deptula-Hicks
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 Number.
(Print or Type Responses) Page 2
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