SEC Form 3
FORM 3 UNITED STATES 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
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
EYLENBOSCH HILDE

(Last) (First) (Middle)
51 SAWYER ROAD, SUITE 100

(Street)
WALTHAM 02453

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/09/2003
3. Issuer Name and Ticker or Trading Symbol
INVERNESS MEDICAL INNOVATIONS INC [ IMA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP - Intl Womens Health
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - 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)
Common Stock 1,766 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) 11/20/2001(4) 12/11/2007 Common Stock 800 $4.32 D
Employee Stock Option (right to buy) 11/20/2001(4) 09/16/2009 Common Stock 400 $1.53 D
Employee Stock Option (right to buy) 11/20/2001(4) 03/19/2010 Common Stock 400 $3.35 D
Employee Stock Option (right to buy) 11/20/2001(4) 02/11/2011 Common Stock 1,200 $14.92 D
Employee Stock Option (right to buy) (1) 11/29/2011 Common Stock 40,000 $15.47 D
Employee Stock Option (right to buy) 08/23/2002 08/22/2012 Common Stock 2,065 $15.55 D
Employee Stock Option (right to buy) (2) 03/09/2013 Common Stock 5,000 $16.2 D
Employee Stock Option (right to buy) 11/20/2001(4) 04/05/2004 Common Stock 2,600 $1.24 I By Spouse(3)
Employee Stock Option (right to buy) 11/20/2001(4) 10/16/2005 Common Stock 2,600 $0.75 I By Spouse(3)
Employee Stock Option (right to buy) 11/20/2001(4) 12/11/2005 Common Stock 4,940 $1.24 I By Spouse(3)
Employee Stock Option (right to buy) 11/20/2001(4) 01/04/2008 Common Stock 503 $4.84 I By Spouse(3)
Employee Stock Option (right to buy) 11/20/2001(4) 10/12/2008 Common Stock 1,200 $1.71 I By Spouse(3)
Employee Stock Option (right to buy) 11/20/2001(4) 05/19/2009 Common Stock 2,500 $1.68 I By Spouse(3)
Employee Stock Option (right to buy) 11/20/2001(4) 09/16/2009 Common Stock 1,200 $1.53 I By Spouse(3)
Employee Stock Option (right to buy) 11/20/2001(4) 04/23/2010 Common Stock 1,200 $2.89 I By Spouse(3)
Employee Stock Option (right to buy) 11/20/2001(4) 02/11/2011 Common Stock 4,000 $14.92 I By Spouse(3)
Explanation of Responses:
1. This option became exercisable as to 10,000 shares on 11/30/2002, as to 10,000 additional shares on 11/30/2003 and will become exercisable as to the remaining 20,000 shares in two equal annual installments beginning on 11/30/2004.
2. This option will become exercisable in four equal annual installments beginning on 3/10/2004.
3. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or any other purpose.
4. This option was acquired through a restructuring transaction undertaken by the Issuer's former parent Inverness Medical Technology, Inc. in connection with the consummation of the transactions contemplated by the agreement and plan of split-off and merger dated as of May 23, 2001 among Johnson & Johnson, Sunrise Acquisition Corp. and Inverness Medical Techology, Inc.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Jay McNamara, Attorney in Fact 12/19/2003
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** 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 is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.