FORM 3
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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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1. Name and Address of Reporting Person
Fletcher Don C., Jr.
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(Last) (First) (Middle)
1205 South Dupont Street
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(Street)
Ontario CA 91761
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
9/5/00
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
###-##-####
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4. Issuer Name and Ticker or Trading Symbol
LifePoint, Inc. - LFP
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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)
Vice President, Operations
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6. If Amendment, Date of Original (Month/Day/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. 4)
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<S> <C> <C> <C>
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None
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
<PAGE>
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 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
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Common Stock Option (1) 8/24/10 Common Stock, $.001 45,000 $4.75 D N/A
par value
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Common Stock Option (2) 8/24/10 Common Stock, $.001 20,000 $4.75 D N/A
par value
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Common Stock Option (3) 8/24/10 Common Stock, $.001 20,000 $4.75 D N/A
par value
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</TABLE>
Explanation of Responses:
(1) Becomes exercisable as to 11,250 shares on 8/25/01; becomes exercisable as
to 938 shares on the 30th day of each month for 35 months thereafter and
becomes exercisable as to 920 shares on the 30th day of the 36th month
thereafter.
(2) Option becomes exercisable only if the Company's saliva based testing
product is released to market during the quarter ended March 31, 2001 and at
least a specified amount of revenues is obtained doing the quarter ended June
30, 2001.
(3) Option becomes exercisable only if the Issuer achieves its fiscal year 2002
manufacturing goal for its saliva based testing product, which will be set by
the Board of Directors of the Issuer in the fiscal year 2002 annual budget.
/s/ Don C. Fletcher, Jr. 9/7/00
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Don C. Fletcher, Jr. 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.
