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- ------ U.S. SECURITIES AND EXCHANGE COMMISSION ------------------------------
FORM 4 WASHINGTON, DC 20549 OMB APPROVAL
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STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0287
[ ] Check box if no Expires: September 30, 1998
longer subject to Filed pursuant to Section 16(a) of the Securities Estimated average burden
Section 16. Form 4 Exchange Act of 1934, Section 17(a) of the hours per response.........0.5
or Form 5 obligations Public Utility Holding Company Act of 1935 ------------------------------
may continue. See or Section 30(f) of the Investment Company
Instruction 1(b). Act of 1940
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Lombardi Carl A. SLMD Issuer (Check all applicable)
- --------------------------------------------- ---------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
c/o Spacelabs Medical, Inc. Number of Reporting Month/Year X Officer (give Other (Specify
15220 NE 40th St. Person (Voluntary) 11/99 ---- title --- below)
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(Street) 5. If Amendment, Chairman of the Board,
Redmond WA 98052 Date of Original President and CEO
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(City) (State) (Zip) 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 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
Spacelabs Medical, Inc. (Instr. 8) End of Month Direct Benefi-
(Month/ (Instr. 3 and 4) (D) or cial
Day/ --------------------------------------- Indirect Owner-
Year) Code V Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
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Common Stock 11/3/99 P 5,000 A $13.375 148,300 D
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*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)
(Print or Type Response) SEC 1474 (7/96)
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FORM 4 (CONTINUED) 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 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Expiration Securities Deriv-
Price of (Month/ (Instr. Acquired (A) Date (Instr. 3 and 4) ative
Deriv- Day/ 8) or Disposed (Month/Day/ Secur-
ative Year) of (D) (Instr. Year) ity
Security 3, 4, and 5) (Instr. 5)
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Date Expira- Amount or
-------------------------- Exer- tion Title Number of
Code V (A) (D) cisable Date Shares
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1. Title of Derivative 9. Number of 10. Ownership 11. Nature of
Security Derivative Form of Indirect
(Instr. 3) Securities Derivative Beneficial
Beneficially Security: Ownership
Owned at End Direct (D) (Instr. 4)
of Month or Indirect (I)
(Instr. 4) (Instr. 4)
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Explanation of Responses:
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ EUGENE V. DEFELICE 11/10/99
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- --------
**Signature of Reporting Person Date
Eugene V. DeFelice
Attorney in Fact for
Carl A. Lombardi
Note: File three copies of this Form, one of which must be manually signed. Page 2
If space provided is insufficient, see Instruction 6 for procedure. SEC 1474 (7-96)
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB Number.
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