-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Why2C5bixW5snwLcApnnqXNFk34R2dOznjuQG3Cvuv8Vk9WSyuwxershsuzi2Nph Fx2p1mvn82LK3R29QrKA5g== 0000827056-03-000001.txt : 20030224 0000827056-03-000001.hdr.sgml : 20030224 20030224084754 ACCESSION NUMBER: 0000827056-03-000001 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030224 FILED AS OF DATE: 20030224 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SHANAMAN RICHARD L CENTRAL INDEX KEY: 0001219312 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 3 MAIL ADDRESS: STREET 1: PO BOX 5241 CITY: BLAKELEY ISLAND STATE: WA ZIP: 98222 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ZEVEX INTERNATIONAL INC CENTRAL INDEX KEY: 0000827056 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 870462807 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12965 FILM NUMBER: 03576755 BUSINESS ADDRESS: STREET 1: 4314 ZEVEX PARK LANE CITY: MURRAY STATE: UT ZIP: 84123 BUSINESS PHONE: 8012641001 MAIL ADDRESS: STREET 1: 4314 ZEVEX PARK LANE CITY: MURRAY STATE: UT ZIP: 84123 FORMER COMPANY: FORMER CONFORMED NAME: DOWNEY INDUSTRIES INC DATE OF NAME CHANGE: 19880811 3 1 f3rls022403.txt ZEVEX INTERNATIONAL 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 1. Name and Address of Reporting Person Richard L. Shanaman 2714 East 6200 South Salt Lake City, Ut 84120 2. Date of Event Requiring Statement (Month/Day/Year) February/20/2003 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Issuer Name and Ticker or Trading Symbol ZEVEX, International, Inc. (ZVXI) 5. Relationship of Reporting Person to Issuer (Check all applicable) Director x 10% Owner Officer (Title): Other 6. If Amendment, Date of Original (Month/Day/Year) Table 1 -- Non-Derivative Securities Beneficially Owned 1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr.5) 4. Nature of Indirect Beneficial Ownership (Instr. 5) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security (Instr. 4) COMMON 2. Date Exercisable and Expiration Date (Month/Day/Year) Exercisable: February/20/2004* Expiration: February/20/2010 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) Title: NONQUALIFIED OPTION Amount or Number of Shares: 10000 4. Conversion or Exercise Price of Derivative Security: $2.16 5. Ownership Form of Derivative Security: Direct (D), or Indirect (I) (Instr. 5) D 6. Nature of Indirect Beneficial Ownership (Instr. 5) *Grant to reporting person options to buy 10,000 shares of Common Stock in transaction exempt under Rule 16b-3. The option becomes exercisable in annual increments of 2,500 each, beginning February 20, 2004, the first anniversary of the original grant. Explanation of Responses: Signature of Reporting Person /s/ John T. Lemley Date: February/20/2003 - ------------------ **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a) -----END PRIVACY-ENHANCED MESSAGE-----