SEC FORM 3 SEC Form 3
FORM 3 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
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
DUCA PARTNERSHIP

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/06/2004
3. Issuer Name and Ticker or Trading Symbol
IMPAC MEDICAL SYSTEMS INC [ IMPC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock $154,463(1) I by Duca Partnership
Common Stock $72,802(2) I by Pension Plan
Common Stock $2,095(3) I by Trust
Common Stock $10,000(4) I by Trust
Common Stock $154,463(5) D
Common Stock $17,701(6) I by Trust
Common Stock $3,400(7) I by Trust
Common Stock $1,000(8) D
Common Stock $250(9) D
Common Stock $450(10) D
Common Stock $3,595(11) D
Common Stock $3,595(12) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
DUCA PARTNERSHIP

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
1. Name and Address of Reporting Person*
DUCA SUZANNE S

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
1. Name and Address of Reporting Person*
DUCA LINDSEY

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
1. Name and Address of Reporting Person*
HERBERT ALFRED K

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
1. Name and Address of Reporting Person*
HERBERT LINDA J

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
1. Name and Address of Reporting Person*
HERBERT KAREN

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
1. Name and Address of Reporting Person*
DUCA LORRAINE

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
1. Name and Address of Reporting Person*
LIPKOVITS JEANNE A

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
1. Name and Address of Reporting Person*
DUCA MAURICE J

(Last) (First) (Middle)
1485 EAST VALLEY ROAD, SUITE H

(Street)
SANTA BARBARA CA 93108

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
mem of 13d grp owning more 10%
Explanation of Responses:
1. These securities are held in the name of the Duca Partnership and reported by Maurice J. Duca and Suzanne S. Duca as trustees of the Maurice J. Duca Family Trust and the Suzanne S. Duca Separate Property Trust, respectively, the general partners of the Duca Partnership.
2. These securities are held by the Investment Group of Santa Barbara Money Purchase Pension Plan FBO Maurice J. Duca and reported by Maurice J. Duca in his capacity as trustee.
3. These securities are held by the Marie Duca Educational Trust and reported by Maurice J. Duca in his capacity as trustee.
4. These securities are held by the LaCentra-Sumerlin Charitable Remainder Unitrust and reported by Maurice J. Duca and Suzanne S. Duca in their capacities as trustees.
5. These securities are held by the Duca Partnership.
6. These securities are held by the Lindsey Duca Trust and reported by Lindsey Duca in her capacity as trustee.
7. These securities are held by the Herbert Family Trust and reported by Alfred K. Herbert and Linda J. Herbert in their capacities as trustees.
8. These securities are owned solely by Alfred K. Herbert.
9. These securities are owned solely by Linda J. Herbert.
10. These securities are owned solely by Karen Herbert.
11. These securities are owned solely by Lorraine Duca.
12. These securities are owned solely by Jeanne A. Lipkovits.
Remarks:
The reporting person is a member of a Section 13(d) group that owns more than 10% of the issuers outstanding common stock (the "IGSB Group"). Each of the reporting persons who are joint filers included in this Form 3 are members of the IGSB Group. Two additional Forms 3 filed by IGSB-Karan I, LLC and William R. Rauth III, as designated filers, which relate to the same event requiring this statement, list additional joint filers that are members of the IGSB Group. Each of the reporting persons that are members of the IGSB Group disclaim ownership of the shares reported, except to the extent of their pecuniary interest therein.
/s/ Maurice J. Duca 02/12/2004
** Signature of Reporting Person Date
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 5 (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.
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