FORM 3
UNITED STATES 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 REPORTING PERSON:
Falgoust Serena Jane
(Last) (First) (Middle)
1620 North 1250 West
(Address)
Provo UT 84604
(City) (State) (Zip)
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2. DATE OF EVENT REQUIRING STATEMENT (Month/Day/Year)
January 2, 1998
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3. IRS OR SOCIAL SECURITY NUMBER OF REPORTING PERSON (Voluntary)
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<PAGE>
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4. ISSUER NAME AND TICKER OR TRADING SYMBOL
Interwest Home Medical, Inc. - IWHM
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5. RELATIONSHIP OF REPORTING PERSON(S) TO ISSUER - Check all applicable
______ Director _____ 10% Owner
__X___ Officer (give title _____ Other (specify below)
below)
Secretary
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6. IF AMENDMENT, DATE OF ORIGINAL (Month/Day/Year)
N/A
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<TABLE>
<CAPTION>
TABLE 1 - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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<S> <C> <C> <C>
1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect Beneficial
(Instr. 4) Beneficially Owned Direct (D) or Ownership (Instr. 5)
(Instr. 4) Indirect (I)
(Instr. 5)
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Interwest Home Medical, Inc.- 25,000 D
Common Stock
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</TABLE>
<TABLE>
<CAPTION>
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED
(e.g. puts, calls, warrants, options, convertible securities)
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<S> <C> <C> <C> <C> <C>
1. Title of Derivative 2. Date Exercisable 3. Title and Amount of 4. Conversion or 5. Ownership 6. Nature of
Security (Instr. 4) and Expiration Securitiea Underlying Exercise Price Form of Indirect
Date Derivative Security of Derivative Derivative Beneficial
(Month/Day/Year) (Instr. 4) Security Security; Ownership
_____________________ _________________________ Direct (D) (Instr. 5)
Date Expiration Title Amount or or Indirect
Exercisable Date Number of (I)(Instr. 5)
Shares
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</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 is insufficient, See Instruction 6 for procedure.
Date: December 14, 2000 /s/ Serena J. Falgoust
**Signature of Reporting Person
