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,
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)
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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 ----------------------------------
950 Tower Lane, Suite 800 ---------------------------- 5. Relationship of Reporting -----------------------
---------------------------------------- 3. I.R.S. 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)
-------------------------------------- ----- ----- Form filed by
(City) (State) (Zip) ---------------------------- Officer Other ----- One Reporting
----- (give ----- (specify Person
title below) below) X Form filed by
----- More than One
---------------------------------- Reporting Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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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)
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Common Stock 2,517,218 D (1)
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Common Stock 363,310 D (2)
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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)
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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/Year) (Instr. 4) Price of Deriv-
Deriv- ative
ative Security:
Security Direct
----------------------------------------------- (D) or
Date Expira- Amount or Indirect (I)
Exercis- tion Title Number (Instr. 5)
able Date of Shares
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Explanation of Responses:
(1) Shares held by H.J. Smead. H.J. Smead is a managing partner of Foster City LLC. Foster City LLC disclaims beneficial ownership
except to the extent of any pecuniary interest therein.
(2) Shares held by Edward Durbin. Edward Durbin is a managing partner of Foster City LLC. Foster City LLC disclaims any
beneficial ownership except to the extent of any pecuniary interest therein.
SEE ATTACHED SCHEDULE
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**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 to respond unless the form displays a currently valid OMB Number.
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FOSTER CITY LLC
SCHEDULE FOR FORM 3
MANAGING MEMBERS OF FOSTER CITY LLC
H. J. Smead
Edward Durbin
By: /s/ H.J. SMEAD By: /s/ EDWARD DURBIN
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H.J. Smead Edward Durbin
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