FORM 5
[ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. SEE Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
ANNUAL 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
1. Name and Address of Reporting Person*
PRESTON JACK D.
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(Last) (First) (Middle)
C/O DENTAL/MEDICAL DIAGNOSTIC SYSTEMS, INC.
200 N. WESTLAKE BLVD, SUITE 202
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(Street)
WESTLAKE VILLAGE, CA 91362
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
DENTAL/MEDICAL DIAGNOSTIC SYSTEMS, INC. (DMDS)
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
2/99
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5. If Amendment, Date of Original (Month/Year)
2/99
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6. Relationship of Reporting Person to Issuer (Check all applicable)
[X] Director [ ] 10% Owner
[X[ Officer (give title below) [ ] Other (specify below)
EXECUTIVE VICE PRESIDENT
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7. Individual 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 I -- NON-DERIVATIVE SECURITIES ACQUIRED,
DISPOSED OF, OR BENEFICIALLY OWNED
<TABLE>
<CAPTION>
1. Title of Security (Instr. 3) 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of
action action or Disposed of (D) Securities Form; Indirect
Date Code (Instr. 3, 4 and 5) Beneficially Direct Beneficial
(Month/ (Instr. ----------------------- Owned at End of (D) or Ownership
Day/ 8) Amount (A) or Price Issuer's Fiscal Indirect (Instr. 4)
Year) (D) Year (Instr. 3 (I)
and 4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
COMMON STOCK 8/20/98 P 1,000 A $4.50 10,500 D *
</TABLE>
If the form is filed by more than one Reporting Person, see Instruction 4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Over)
<PAGE>
FORM 5 (CONTINUED)
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<TABLE>
<CAPTION>
1.Title 2.Conver- 3.Trans- 4.Trans- 5.No. of 6.Date Exer- 7.Title and 8.Price 9.Number 10.Owner- 11.Nature
of Deri- sion or action action Deri- cisable Amount of of of Deriv- ship of of In-
vative Exercise Date Code vative and Expi- Underlying Deri- ative Deriva- direct
Security Price of (Month/ (Instr. Securi- ration Securities vative Securities tive Bene-
(Instr. 3) Deri- Day/ 8) ties Ac- Date (Month/ (Instr. 3 Security Bene- Security; ficial
vative Year) quired Day/Year) and 4) (Instr. 5) ficially Direct (D) Owner-
Security (A) or Owned at or Indi- ship
Disposed End of rect (I) (Instr.
of (D) Year (Instr. 4) 4)
(Instr. 3, (Instr. 4)
4, and 5)
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(A) (D) Date Expira- Amt. or
Exer- tion Title No. of
cis- Date Shares
able
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
</TABLE>
Explanation of Responses:
**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.
/S/ JACK D. PRESTON December 28, 1999
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**Signature of Reporting Person Date
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