- -------- U.S. SECURITIES AND EXCHANGE COMMISSION ----------------------------- FORM 3 WASHINGTON, D.C. 20549 OMB APPROVAL - -------- ----------------------------- INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES OMB NUMBER: 3235-0104 EXPIRES: APRIL 30, 1997 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 0.5 Section 30(f) of the Investment Company Act of 1940 ----------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person 2. Date of Event Re- 4. Issuer Name and Ticker or Trading Symbol quiring Statement Tomasello Anthony J (Month/Day/Year) Stericycle, Inc. (SRCL) - ------------------------------------------------- ------------------------------------------------------------ (Last) (First) (Middle) 8/22/96 5. Relationship of Reporting Person 6. If Amendment, Date ----------------------- to Issuer (Check all applicable) of Original 1208 Canterbury Circle 3. IRS or Social Se- Director 10% Owner (Month/Day/Year) - ------------------------------------------------- curity Number of ---- ---- (Street) Reporting Person X Officer (give Other (Voluntary) ----title below) ----(specify below) 8/22/96 Vice President, Operations -------------------------------- Libertyville, IL 60048 ###-##-#### - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5) (Instr. 4) (D) or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 118,572 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses) SEC 1473 (8-92)
FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial Expiration (Instr. 4) Exercise Form of Ownership Date Price of Deriv- (Instr. 5) (Month/Day/ Deri- ative Year) vative Security: -------------------------------------------------- Security Direct Amount (D) or Date Expir- or Indirect Exer- ation Title Number (I) cisable Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options (1) 11/1/05 Common Stock 4,414 $.53 D (right to purchase) - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Options (2) 1/29/06 Common Stock 1,633 $.53 D (right to purchase) - ------------------------------------------------------------------------------------------------------------------------------------ Warrants (right to buy) 5/31/96 5/31/01 Common Stock 12,432 $7.96 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) 136.15 of these options become exercisable on the first day of each month beginning on September 1, 1996 and ending on November 1, 1996; 10.21 of these options become exercisable on the first day of each month beginning with September 1, 1996 and ending on November 1, 1997; and 6.63 of these options become exercisable on the first day of each month beginning with September 1, 1996 and ending on November 1, 1998. (2) 326.6 of these options become exercisable on the first day of each month beginning on September 1, 1996 and ending on Janury 1, 1997. s/ Anthony J. Tomasello 8/23/96 ------------------------------------- ---------------------- **Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date 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 provided is insufficient, SEE Instruction 6 for procedure. Page 2 SEC 1473 (8-92)