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FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
- ------ Washington, D.C. 20549 -------------------------------
OMB Number: 3235-0104
Expires: October 31, 2001
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Estimated average burden
hours per response..........0.5
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(Print or
Type Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility
Responses) Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
<CAPTION>
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<S> <C> <C>
1. Name and Address of Reporting Person* 2. Date of Event 4. Issuer Name
Requiring and Ticker
Khera Ashish Statement or Trading Symbol
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(Last) (First) (Middle) Conceptus, Inc.
04/27/00 (CPTS)
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3. I.R.S 5. Relationship of
Identification Reporting Person(s)
641 42nd. Ave. Number of to Issuer
- ------------------------------------------ Reporting (Check all applicable)
(Street) Person, if an
entity (voluntary) --- Director --- 10% Owner
X Officer --- Other
(give title (specify
below) below)
V.P. Research & Development
San Mateo, CA 94403 ------------------------------
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(City) (State) (Zip)
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Table I - Non-Derivative Securities Beneficially Owned
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1. Title of Security 2. Amount of Securities 3. Ownership
(Instr. 4) Beneficially Owned Form: Direct
(Instr. 4) (D) or
Indirect (I)
(Instr. 5)
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Common Stock 2,584 D
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FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<S> <C> <C> <C> <C>
1. Title of Derivative Security 2. Date Exer- 3. Title and Amount 4. Conver- 5. Owner-
(Instr. 4) cisable and of Securities sion or ship
Expiration Underlying Derivative Exercise Form of
Date Security (Instr. 4) Price of Deriv-
(Month/ Derivative ative
Day/Year) Security Security:
---------------------------------------- Direct
Date Expira- Amount (D) or
Exer- tion Title or Indirect
cisable Date Number of (I)
Shares (Instr. 5)
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Option 4/27/00 7/08 ISO 49,331 $1.25 D
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Option 4/27/00 5/05 ISO 1,181 $0.48 D
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Option 4/27/00 4/08 ISO 4,000 $3.50 D
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Option 4/27/00 4/08 ISO 1,700 $2.63 D
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