FORM 4
OMB Approval
OMB Number 3235-0362
Expires: February 1, 1994
U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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 if no longer subject to Section 16, Form 4 or Form 5, Obligation may
continue. (See Instructions)
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<S> <C>
1. Name and Address of Reporting Person: Lozowicki, Marek
43 Taunton Green, 3rd Floor
Taunton, MA 02780
2. Issuer Name and Ticker or Trading Symbol: National Boston Medical, Inc.
3. IRS or SSN of Reporting Person (Voluntary):
4. Statement for Month/Year
5. If Amendment, Date of Original:
6. Relation of Reporting Person to Issuer _ Director
_ 10% owner
X Officer (Title): V.P.,
Secretary
_ Other (Specify)
X Filed by One Reporting Person.
_ Filed by more than One Reporting Person.
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TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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<S> <C> <C>
1. Title of Security: Common Stock Options
2. Transaction Date: 11/12/99
3. Transaction Code P V
4. Securities Acquired (A) or
Disposed (D): Amount: 150,000
A or D: A
Price: $27,000
5. Amount of Securities 1,112,500 400,000
Beneficially owned at end
of Month:
6. Ownership Form: D D
Direct (D) or Indirect (I):
7. Nature of Indirect
Beneficial Ownership:
</TABLE>
*If the form is filed by more than one Reporting Person, see instruction 5(b)(v)
Reminder: Report on a separate Line for each class of securities beneficially
owned directly or indirectly.
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FORM 4 (continued)
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED
1. Title of Derivative Security: N/A
2. Conversion or Exercise Price of Derivative Security:
3. Transaction Date (M/D/Y):
4. Transaction Code:
V:
5. Number of Derivative Securities Acquired (A) or Disposed of (D):
6. Date Exercisable:
Expiration Date:
7. Title of Underlying Securities:
Amount or number of Shares:
8. Price of Derivative Security:
9. Number of Derivative Securities Beneficially Owned at end of Month:
10. Ownership of Derivative Securities;
(D) Direct or (I) Indirect:
11. Nature of Indirect Beneficial Ownership:
EXPLANATION OF RESPONSES:
/s/ Marek Lozowicki Date: Dec 2, 1999
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**Signature of Reporting Person
**Intentional misstatements or omissions of facts constitute Federal Criminal
Violations. See Sections 18 U.S.C. 1001, 15 U.S.C. 78ff(a).
