U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENFICIAL OWNERSHIP
1. Name and Address of Reporting Person:
Kirk Blosch, 2081 S. Lakeline Drive, Salt Lake City, UT 84109
2. Issuer Name and Ticker or Trading Symbol:
ZEVEX International, ZVXI.
3. IRS or Social Security Number of Reporting Person (Voluntary):
4. Statement for Month/Year:
12/98
5. If Amendment, Date of Original (Month/Year):
6. Relationship of Reporting Person to Issuer (Check all applicable):
(X) Director ( ) Officer (give title below)
( ) 10% Owner ( ) Other (specify below)
Title: Director
TABLE I -- Non-Derivative Securities Beneficially Owned
<TABLE>
<CAPTION>
<S> <C> <C> <C> <C> <C> <C>
1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount 6. Owner- 7. Nature
action action or Disposed of (D) of ship of In-
Date Code Securities Form direct
(M/D/Y) Beneficially Direct Benefic-
Owned at (D) or ial
End of Indirect Owner-
Amount (A) or (D) Price Month (I) ship
- --------------------- ------------ ------------ -------------------------------- ------------ ------------ ----------
</TABLE>
TABLE II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
<TABLE>
<CAPTION>
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
1. Title of 2. Conver- 3.Trans- 4. Trans- 5. Number of 6. Date 7. Title and 8. Price 9. Num- 10. Own- 11. Na-
Deriv- sion or action action Derivative Exer- and Am- of ber of ership ture
ative Exercise Date Code Securities cisable ount of Deriv- Deriv- Form of In-
Security Price of (M/D/Y) Acquired and Ex- Under- ative ative of De- direct
Deriv- (A) or Dis- piration lying Secur- Secur- rivative Benef-
ative posed of (D) Date Securities ity ities Security: icial
Security (M/D/Y) Bene- Direct (D) Own
------------ ------------ ficially or Indirect ership
Date Epir- Title Amount Owned (I)
Exer- ation or Number at End of
cisable Date of Shares Month
- ---------- ----------- --------- -------- -------------- --------------- ------------- --------- ----------- ---------- ------
Employee
Stock
Option
(Right to
Buy) 5.00 10/22/98 J* 10,000 06/04/99 06/03/03 Common Stock 10,000 - 185,000 D
Employee
Stock
Option
(Right to
Buy) 8.94 10/22/98 H** 10,000 06/04/99 06/03/03 Common Stock 10,000
</TABLE>
* Grant to reporting person of options to buy 10,000 shares of Common Stock in
transaction exempt under Rule 16b-3. The option becomes exercisable in annual
increments of 2,500 each, beginning June 5, 1999, the first anniversary
of the original grant.
** Cancellation of option to buy 10,000 shares of Common Stock in exchange for
grant of option to buy 10,000 shares, in transaction exempt under Rule 16b-3