FORM 4
UNITED STATES 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 box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
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1. NAME AND ADDRESS OF REPORTING PERSON:
Nelson Jerald L.
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(Last) (First) (Middle)
10242 Ashley Hills Circle
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(Street)
Sandy, Utah 84092
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(City) (State) (Zip)
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2. ISSUER NAME AND TICKER OR TRADING SYMBOL
Interwest Home Medical, Inc. - IWHM
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3. IRS OR SOCIAL SECURITY NUMBER OF REPORTING PERSON (Voluntary)
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<PAGE>
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4. Statement for Month/Year
April, 2000
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5. If Amendment, Date of Original (Month/Year)
N/A
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6. RELATIONSHIP OF REPORTING PERSON(S) TO ISSUER - Check all applicable
__X__ Director _____ 10% Owner
_____ Officer (give title _____ Other (specify below)
below)
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TABLE 1 - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security (Instr. 3)
Interwest Home Medical, Inc. - Common Stock
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2 Transaction Date - (Month/Day/Year)
April 25, 2000
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3. Transaction Code - (Instr. 8)
Code V
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C
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4. Secutities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
Amount (A) or (D) Price
5,000 A 4.00
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5. Amount of Securities, Beneficially Owned at End of Month
(Instr. 3 and 4)
31,565
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6. Ownership Form - Direct (D) or Indirect (I) - (Instr. 4)
D
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7. Nature of Indirect Beneficial Ownership - (Instr. 4)
N/A
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TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g. puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security - (Instr. 3)
Stock Option - Right to Buy
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2. Converstion or Exervice Price of Derivative Security
4.00
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3. Transaction Date - (Momth/Day/Year)
April 25, 2000
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4. Transaction Code (Instr. 8)
Code V
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C
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5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.3,
4 and 5)
(A) (D)
5,000
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6. Date Exercisable and Expiration Date: (Month/Day/Year)
Date Exercisable Expiration Date
3/31/98 3/31/07
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7. Title and Amount of Underlying Securities - (Instr. 3 and 4)
Title Amount or Number of Shares
Common Stock 5,000
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8. Price of Derivative Security (Instr. 5)
4.00
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9. Number of Derivative Securities Beneficially Owned at End of Month
(Instr. 4)
82,000
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10. Ownership Form of Derivative Security; Direct (D) or Indirect (I) -
(Instr. 4)
D
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11. Nature of Indirect Beneficial Onwerhsip (Instr. 4)
N/A
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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 is insufficient, See Instruction 6 for procedure.
Date: December 13, 2000 /s/ Jerald L. Nelson
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**Signature of Reporting Person
