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FORM 3 OMB APPROVAL
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OMB Number: 3235-0104
Expires: September 30, 1998
Estimated average burden
hours per response ...... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 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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<S> <C> <C> <C>
(Print or Type Responses)
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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
Larsen Dennis E. Statement Trading Symbol of Original
- ---------------------------------------- (Month/Day/Year) Spacelabs Medical, Inc. (SLMD) (Month/Day/Year)
(Last) (First) (Middle) ---------------------------------- December 7, 1998
14315 NE 61st Street ---------------------------- 5. Relationship of Reporting -----------------------
- ---------------------------------------- 3. IRS or Social Security Person to Issuer 7. Individual or Joint/
(Street) Number of Reporting (Check all applicable) Group Filing (Check
Redmond WA 98052 Person (Voluntary) Director 10% Owner applicable line)
- -------------------------------------- ----- ----- X Form filed by
(City) (State) (Zip) ---------------------------- X Officer Other ----- One Reporting
----- (give ----- (specify Person
title below) below) Form filed by
Vice President ----- More than One
---------------------------------- Reporting Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 5)
(Instr. 5)
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Common Stock 1,181 I Shares held in Company's 401(K) Plan
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Common Stock 2,000(1) D
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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).
(Over)
(8/96)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C>
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deriv- ative
ative Security:
Security
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Date Expira- Amount or (D) or
Exercis- tion Title Number Indirect (I)
able Date of Shares (Instr. 5)
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Stock Option At Present 7/23/2002 Common Stock 20,000 $22.13 D
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Stock Option At Present 3/25/2003 Common Stock 10,000 $18.00 D
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Stock Option At Present 2/03/2004 Common Stock 10,000 $25.50 D
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Stock Option At Present 3/17/2005 Common Stock 3,264 $22.9375 D
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Stock Option At Present 2/17/2006 Common Stock 4,230 $22.9375 D
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Explanation of Responses:
(1) Granted pursuant to Spacelabs Medical, Inc's 1992 Option, Stock Appreciation
Right, Restricted Stock, Stock Grant, and Performance Unit Plan which is
exempt under Rule 16b-3.
By: Eugene V. DeFelice January 7, 2000
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**Signature of Reporting Person Date
Attorney-in-Fact for Dennis E. Larsen
**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 provided is insufficient, See Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained in this form Page 2 of 2
are not required to respond unless the form displays a currently valid OMB Number. SEC 1473 (7/96)
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