-----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, JzoniJ414c3a+OJkgXxcPnFdUoAah8TaJ6Z6toR17qhNpOGL/PrneFRZbcuzWUaU mR2X9I2bQwu+GASmw7C4tg== 0000891618-00-001611.txt : 20000322 0000891618-00-001611.hdr.sgml : 20000322 ACCESSION NUMBER: 0000891618-00-001611 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991201 FILED AS OF DATE: 20000321 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTEVAC INC CENTRAL INDEX KEY: 0001001902 STANDARD INDUSTRIAL CLASSIFICATION: SPECIAL INDUSTRY MACHINERY, NEC [3559] IRS NUMBER: 943125814 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-26946 FILM NUMBER: 574736 BUSINESS ADDRESS: STREET 1: 355O BASSETT ST CITY: SANTA CLARA STATE: CA ZIP: 95054 BUSINESS PHONE: 4089869888 MAIL ADDRESS: STREET 1: 3550 BASSETT STREET CITY: SANTA CLARA STATE: CA ZIP: 95054 COMPANY DATA: COMPANY CONFORMED NAME: FOSTER CITY LLC CENTRAL INDEX KEY: 0001100888 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 950 TOWER LN STREET 2: STE 800 CITY: FOSTER CITY STATE: CA ZIP: 94404 BUSINESS PHONE: 6503497400 MAIL ADDRESS: STREET 1: 950 TOWER LN STREET 2: STE 800 CITY: FOSTER CITY STATE: CA ZIP: 94404 3 1 FORM 3 1 - -------- ------------------------------ FORM 3 OMB APPROVAL - -------- ------------------------------ OMB Number: 3235-014 Expires: December 31, 2001 Estimated average burden hours per response ........0.5 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 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 (Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Foster City LLC Statement Trading Symbol of Original - ---------------------------------------- (Month/Day/Year) Intevac, Inc.- IVAC (Month/Day/Year) (Last) (First) (Middle) December 1, 1999 ---------------------------------- 12/10/99 950 Tower Lane, Suite 800 ---------------------------- 5. Relationship of Reporting ----------------------- - ---------------------------------------- 3. IRS Identification Person(s) to Issuer 7. Individual or Joint/ (Street) Number of Reporting (Check all applicable) Group (Check Foster City CA 94404 Person, if an entity Director X 10% Owner Applicable Line) - -------------------------------------- (Voluntary) ----- ----- X Form filed by (City) (State) (Zip) ---------------------------- Officer Other ----- One Reporting ----- (give ----- (specify Person title below) below) Form filed by ----- More than One ---------------------------------- Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 5,600,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) *If the form is filed by more than one reporting person, see Instruction 5(b)(v). SEC 1473 (3-99)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deriv- ative ative Security: Security ------------------------------------------------- Direct Date Expira- Amount or (D) or Exercis- tion Title Number Indirect (I) able Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: /s/ JOHN CHAPIN 2/22/00 ---------------------------------- ---------------- **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. Page 2 If space is insufficient, See Instruction 6 for procedure. SEC 1473 (3-99) Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently value OMB Number.
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