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
1. Name and Address of Reporting Person*
Jeffrey L. Grayson
2300 SW First Avenue, Suite 200
Portland, OR 97201
2. Date of Event Requiring Statement (Month/Day/Year)
09/22/99
3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
4. Issuer Name and Ticker or Trading Symbol
AFEM Medical Corporation
5. Relationship of Reporting Person(s) to Issuer (Check All Applicable)
/ / Director
/ / Officer (give title below)
/X/ 10% Owner
/ / Other (specify below)
6. If Amendment, Date of Original (Month/Day/Year)
N/A
7. Individual or Joint/Group Filing (Check Applicable Line)
/X/ Form filed by One Reporting Person
/ / Form filed by More than One Report Person
<TABLE>
<CAPTION>
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Table 1 -- Non-Derivative Securities Beneficially Owned
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1. Title of Security (Instr. 4) 2. Amount of Securities 3. Ownership Form: Direct 4. Nature of Indirect
Beneficially Owned (Instr. (D) or Indirect (I) Beneficial Ownership
4) (Instr. 5) (Instr. 5)
- ---------------------------------- -------------------------------- ------------------------------- ---------------------------
<S> <C> <C> <C>
Series A Convertible Preferred 56,429 I Through control of
Stock** Capital Consultants LLC
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction
5(b)(v).
**Series A Convertible Preferred Stock is immediately exercisable into Common
Stock on a 1-to-1 basis.
<PAGE>
<TABLE>
<CAPTION>
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Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
- ------------------------------ ------------------------ ------------------------- -------------- ---------------- -------------
1. Title of 2. Date Exercisable 3. Title and Amount of 4. Conversion 5. Ownership 6. Nature of
Derivative Security and Expiration Date Securities Conversion Form of Indirect
(Instr. 4) (Month/Day/Year) Underlying or Derivative Beneficial
Derivative Security Exercise Security: Ownership
(Instr. 4) Price of Direct (D) (Instr. 5)
Derivative or Indirect
Security (I) (Instr.
5)
- ------------------------------ ------------ ----------- -------------- --------- --------------- ---------------- -------------
Date Expiration Title Amount
Exercisable Date or
Number
of
Shares
- ------------------------------ ------------ ----------- -------------- --------- --------------- ---------------- -------------
<S> <C> <C> <C> C> <C> <C> <C>
Warrants to purchase Series Immediately 08/31/08 Common Stock 562 $.01 I Through
A Convertible Preferred control of
Stock* Capital
Consultants
LLC
- ------------------------------ ------------ ----------- -------------- --------- --------------- ---------------- -------------
</TABLE>
Explanation of Reponses:
*Right to purchase Series A Convertible Preferred Stock; Series A Convertible
Preferred Stock is immediately convertible into Common Stock on a 1-to-1 basis.
/s/ Jeffrey L. Grayson 10/12/99
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Jeffrey L. Grayson Date
* Signature of Reporting Person
