FORM 5 / / Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). / / Form 3 Holdings Reported / / Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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* | 2. | Issuer Name and Ticker or Trading Symbol | 6. | Relationship of Reporting Person(s) to Issuer (Check all applicable) | |||||||||||||||
| Sally F. Chamberlain, Trustee and Beneficiary of the Edward P. Fleischer and Sally F. Fleischer Family Trust | OSI Systems, Inc. "OSIS" | Director | 10% Owner | |||||||||||||||||
| (Last) | (First) | (Middle) | 3. | I.R.S Identification Number of Reporting Person, if an entity (voluntary) | 4. | Statement for Month/Year | Officer (give title below) |
X Other (specify below) |
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| 2404 Via Siena | 6/30/99 | Former 10% Owner | ||||||||||||||||||
| (Street) | 5. | If Amendment, Date of Original (Month/Year) | 7. | Individual or Joint/Group Reporting (check applicable line) Form filed by One Reporting Person X Form filed by More than |
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| La Jolla | CA | 92037 | One Reporting Person | |||||||||||||||||
| (City) | (State) | (Zip) | ||||||||||||||||||
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||||||||||||
| 1. | Title of Security (Instr. 3) |
2. | Transaction Date (Month/ Day/ Year) |
3. | Transaction Code (Instr. 8) |
4. | Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. | Amount of Securities Beneficially Owned at the end of Issuer's Fiscal Year | 6. | Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. | Nature of Indirect Beneficial Ownership (Instr. 4) |
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| (Instr. 3 and 4) | ||||||||||||||||||||||||||||||||
| Amount | (A) or (D) | Price | ||||||||||||||||||||||||||||||
| Common Stock | 1/8/99 | S | 10,000 | D | 10.875 | 955,853 | D | |||||||||||||||||||||||||
| Common Stock | 1/11/99 | S | 10,000 | D | 10.63 | 945,853 | D | |||||||||||||||||||||||||
| Common Stock | 1/12/99 | S | 5,000 | D | 10.50 | 940,853 | D | |||||||||||||||||||||||||
| Common Stock | 1/20/99 | S | 4,000 | D | 10.50 | 936,853 | D | |||||||||||||||||||||||||
| Common Stock | 6/8/99 | S | 9,000 | D | 5.06 | 927,853 | D | |||||||||||||||||||||||||
| Common Stock | 6/21/99 | S | 18,579 | D | 5.00 | 909,274 | D | |||||||||||||||||||||||||
| * If the form is filed by more than one reporting person, see Instruction 4(b)(v). | (Over) | |
| SEC 2270 (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 VALID OMB CONTROL NUMBER.
| FORM 5 (Continued) | Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |
| 1. | Title of Derivative Security (Instr. 3) |
2. | Conversion or Exercise Price of Derivative Security | 3. | Transaction Date (Month/Day/Year) |
4. | Transaction Code (Instr. 8) |
5. | Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. | Date Exercisable and Expiration Date (Month/Day/Year) | |||||||||||||||||
| (A) | (D) | Date Exercisable | Expiration Date | |||||||||||||||||||||||||
| 7. | Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. | Price of Derivative Security (Instr. 5) |
9. | Number of Derivative Securities Beneficially Owned at End of Year (Instr. 4) |
10. | Ownership of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. | Nature of Indirect Beneficial Ownership (Instr. 4) |
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| Title | Amount or Number of Shares | |||||||||||||||||||
Explanation of Responses:
| /s/ Sally F. Chamberlain | 12/22/01 | |||||
| **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | Sally F. Chamberlain, Trust beneficiary |
**Signature of Reporting Person |
Date |
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| Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. | Sally F. Chamberlain, Trustee of the Edward P. Fleischer and Sally F. Fleischer Family Trust |
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| Page 2 SEC 2270 (7-97) |
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