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OMB APPROVAL
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OMB Number 3235-0104
Expires: April 30, 1997
Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
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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1. Name and Address of Reporting Person
Brotchie Ian
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(Last) (First) (Middle)
Unilab Corporation, 967 Mabury Road
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(Street)
San Jose CA 95133
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
January 1, 1999
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Unilab Corporation (ULB)
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5 Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [ ] 10% Owner
[ X ] Officer (give title below) [ ] Other (specify below)
Executive Vice President, Division President of Northern California
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6. If Amendment, Date of Original (Month/Year)
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Table I -- Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr.5)
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<S> <C> <C> <C>
Common Stock,
par value $.01 per share 64,188 D
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
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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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<TABLE>
<CAPTION>
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 7. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Security Exer- tion of Derivative (I) Ownership
(Instr. 4) cisable Date Title Shares Security (Instr.5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Options to Purchase
Common Stock 1/28/99 1/28/08 Common Stock 25,000 2.0625 D
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1/28/00 1/28/08 Common Stock 25,000 2.0625 D
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4/1/98 4/28/07 Common Stock 75,000 0.625 D
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4/28/98 4/28/07 Common Stock 45,000 0.625 D
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4/28/99 4/28/07 Common Stock 45,000 0.625 D
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5/1/95 5/1/05 Common Stock 25,000 5.1875 D
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5/1/96 5/1/05 Common Stock 25,000 5.1875 D
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1/1/96 1/1/05 Common Stock 6,250 4.50 D
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1/1/97 1/1/05 Common Stock 6,250 4.50 D
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1/1/98 1/1/05 Common Stock 6,250 4.50 D
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1/1/99 1/1/05 Common Stock 6,250 4.50 D
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1/25/95 1/25/04 Common Stock 50,000 6.13 D
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1/25/96 1/25/04 Common Stock 50,000 6.13 D
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</TABLE>
Explanation of Responses:
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**Signature of Reporting Person Date
** 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.
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