SEC Form 4

FORM 4

[ ] Check this box if no longer
subject to Section 16. Form 4 or Form
5 obligations may continue.
See Instruction 1(b).

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

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(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Jacobs, Irwin

(Last) (First) (Middle)

c/o Hologic, Inc.

35 Crosby Drive

(Street)

Bedford, MA 01730

(City) (State) (Zip)

2. Issuer Name
and Ticker or Trading Symbol

Hologic, Inc.
HOLX

3. I.R.S. Identification
    Number of Reporting
    Person, if an entity
    (voluntary)

4. Statement for
Month/Day/Year

1/1/2003

5. If Amendment,
Date of Original
(Month/Day/Year)

6. Relationship of Reporting Person(s) to Issuer

(Check all applicable)

X Director 10% Owner

Officer (give title below) Other (specify below)

Description

7. 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 Acquired, Disposed of, or Beneficially Owned

1. Title of Security
(Instr. 3)

2.Transaction
Date
(Month/Day/Year)

2A. Deemed Execution Date, if any
(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 Following
    Reported Transaction(s)

    (Instr. 3 and 4)

6. Owner-
    ship
    Form:
    Direct (D)
    or
    Indirect (I)

    (Instr. 4)

7. Nature of
     Indirect
     Beneficial
     Ownership

    (Instr. 4)

Code

Amount

A/D

Price

4,000

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. Conver-
    sion or
    Exercise
    Price of
    Deri-
    vative
    Security

3. Transaction Date

(Month/
Day/
Year)

3A. Deemed Execution Date, if any

(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(DE) and
Expiration Date(ED)
(Month/Day/Year)

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
    Following
    Reported
    Transaction(s)
    (Instr.4)

10. Owner-
ship
Form of
Deriv-
ative
Securities:
Direct (D)
or
Indirect (I)

(Instr.4)

11. Nature of
      Indirect
      Beneficial
      Ownership
      (Instr.4)

Code

Title

Amount or Number of Shares

Option*(Right to buy)

$1.8125

6/15/1994

12/15/2003

COMMON STOCK

4,000

Option*(Right to buy)

$7.00

6/15/1995

12/15/2004

COMMON STOCK

4,000

Option*(Right to buy)

$18.75

6/15/1996

12/15/2005

COMMON STOCK

8,000

Option*(Right to buy)

$24.00

6/15/1997

12/15/2006

COMMON STOCK

8,000

Option*(Right to buy)

$28.125

6/15/1998

12/15/2007

COMMON STOCK

8,000

Option*(Right to buy)

$11.00

6/15/1999

12/15/2008

COMMON STOCK

8,000

Option*(Right to buy)

$8.875

1/1/2000***

3/9/2009

COMMON STOCK

25,000

Option*(Right to buy)

$5.75

7/1/2000

1/1/2010

COMMON STOCK

3,000

Option*(Right to buy)

$5.3125

7/1/2001

1/1/2011

COMMON STOCK

3,000

Option*(Right to buy)

$9.29

7/1/2002

1/1/2012

COMMON STOCK

3,000

Option*(Right to buy)

$12.21

1/1/2003

3,000

7/1/2003

1/1/2013

COMMON STOCK

3,000

77,000

Explanation of Responses:

*Non-qualified stock option
***Subject to vesting schedule

By:
/s/ Irwin Jacobs 1/3/2003
** Signature of Reporting Person Date

SEC 1474 (9-02)

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 4(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.
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 Number.

JACOBS IRWIN 4