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- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION
FORM 3 WASHINGTON, D.C. 20549
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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 2. Date of Event Re- 4. Issuer Name and Ticker or Trading Symbol
quiring Statement
Farm Bureau Life Insurance (Month/Day/Year)
(See Attachment)(1) Image Guided Technologies, Inc./IGTI
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(Last) (First) (Middle) 5. Relationship of Reporting Person(s) 6. If Amendment, Date
----------------------- to Issuer (Check all applicable) of Original
3. IRS or Social Se- Director X 10% Owner (Month/Day/Year)
curity Number of ---- ----
5400 University Avenue Reporting Person Officer (give Other (specify ---------------------
- ------------------------------------------------- (Voluntary) title below) below) 7. Individual or
(Street) ---- ---- Joint/Group Filing
(Check Applicable
Line)
--------------------------- Form filed by One
Reporting Person
---
Form filed by
More than One
X Reporting Person
West Des Moines IA 50266 ---
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(City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial
(Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5)
(Instr. 4) (D) or Indirect
(I) (Instr. 5)
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Common Stock, no par value 88,000 D
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Common Stock, no par value 62,169 I (1) By FBL Ventures of South Dakota
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 1 of 3
(Print or Type Responses) SEC 1473 (7-96)
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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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1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial
Expiration (Instr. 4) Exercise Form of Ownership
Date Price of Deriv- (Instr. 5)
(Month/Day/ Deri- ative
Year) vative Security:
-------------------------------------------------- Security Direct
Amount (D) or
Date Expir- of Indirect
Exer- ation Title Number (I)
cisable Date of
Shares (Instr. 5)
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Series A Preferred Stock (2) (2) Common Stock, 58,516 N/A (1) (I) (2) By FBL Ventures of
no par value South Dakota
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Explanation of Responses:
(1) The Reporting Person is also serving as designated filer for its wholly-owned subsidiary.
Please see attachment
(2) Will be converted without any additional payment into 58,516 shares of the no par value Common Stock of Image Guided
Technologies, Inc. on the Closing Date of its initial public offering.
Farm Bureau Life Insurance
By: Steven G. Hunter, Portfolio Manager
/s/ STEVEN G. HUNTER
By: -------------------------------- October 9, 1996
**Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person
Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
FBL Ventures of South Dakota
By: Steven G. Hunter, Portfolio Manager
/s/ STEVEN G. HUNTER
------------------------------------- October 9, 1996
Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient,
see Instruction 6 for procedure.
Page 2 of 3
SEC 1473 (7-96)
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ATTACHMENT TO INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF
FARM BUREAU LIFE INSURANCE
Farm Bureau Life Insurance has elected to serve as designated filer
for its wholly-owned subsidiary, FBL Ventures of South Dakota. As stated in
the attached Form 3, FBL Ventures of South Dakota directly owns 62,169 shares
of the no par value Common Stock of Image Guided Technologies, Inc. FBL
Ventures of South Dakota also owns the 58,516 shares of no par value Common
Stock of Image Guided Technologies, Inc. which underlie the Series A
Preferred Stock which will convert automatically upon the closing of the
initial public offering. The address of FBL Ventures of South Dakota is 5400
University Avenue, West Des Moines, IA 50266, Attn: Steven Hunter.
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