-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, PVjwSdO7OYcJYXyYRnyWLeXp0q9TP6RgVkENlFdUHXox9Wnrkrikj7XkWeYN7zcI Lr8DqcFI/yI/A7qWBzxFDw== 0001019687-99-000679.txt : 19991105 0001019687-99-000679.hdr.sgml : 19991105 ACCESSION NUMBER: 0001019687-99-000679 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19991104 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PREMIER LASER SYSTEMS INC CENTRAL INDEX KEY: 0000878543 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 330476284 STATE OF INCORPORATION: CA FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: SC 13G SEC ACT: SEC FILE NUMBER: 005-50137 FILM NUMBER: 99740989 BUSINESS ADDRESS: STREET 1: 3 MORGAN CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: 7148590656 MAIL ADDRESS: STREET 1: 3 MORGAN CITY: IRVINE STATE: CA ZIP: 92677 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: COZEAN COLETTE PH D CENTRAL INDEX KEY: 0001098409 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: C/O PREMIR LASER SYSTEMS INC STREET 2: 3 MORGAN CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: 9498590658 MAIL ADDRESS: STREET 1: C/O PREMIER LASER SYSTEMS INC STREET 2: 3 MORGAN CITY: IRVINE STATE: CA ZIP: 92618 SC 13G 1 COLETTE COZEAN, PH.D. ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0145 Expires: October 31, 1994 Estimated average burden hours per response ....... 0.5 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. __)* PREMIER LASER SYSTEMS, INC. - -------------------------------------------------------------------------------- (Name of Issuer) COMMON STOCK - -------------------------------------------------------------------------------- (Title of Class of Securities) 740522107 - -------------------------------------------------------------------------------- (CUSIP Number) JANUARY 31, 1999 - -------------------------------------------------------------------------------- (Date of Event Which Requires Filing of This Statement) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: [ ] Rule 13d-1(b) [X] Rule 13d-1(c) [ ] Rule 13d-1(d) * The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page. The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). SCHEDULE 13G CUSIP No. 740522107 Page 2 of 5 Pages ________________________________________________________________________________ 1. NAME OF REPORTING PERSONS S.S. or I.R.S. IDENTIFICATION NO. OF ABOVE PERSON COLETTE COZEAN, PH.D., SS# ###-##-#### ________________________________________________________________________________ 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [_] (b) [_] ________________________________________________________________________________ 3. SEC USE ONLY ________________________________________________________________________________ 4. CITIZENSHIP OR PLACE OF ORGANIZATION UNITED STATES ________________________________________________________________________________ NUMBER OF 5. SOLE VOTING POWER SHARES 1,007,820 SHARES OF COMMON STOCK** _________________________________________________________________ BENEFICIALLY 6. SHARED VOTING POWER OWNED BY NOT APPLICABLE _________________________________________________________________ EACH 7. SOLE DISPOSITIVE POWER REPORTING 1,007,820 SHARES OF COMMON STOCK** _________________________________________________________________ PERSON 8. SHARED DISPOSITIVE POWER WITH NOT APPLICABLE ________________________________________________________________________________ 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,007,820 SHARES OF COMMON STOCK** ________________________________________________________________________________ 10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [_] ________________________________________________________________________________ 11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 5.3% OF TOTAL SHARES OUTSTANDING OF 18,149,819 AS OF OCTOBER 5, 1999 ________________________________________________________________________________ 12. TYPE OF REPORTING PERSON* IN ________________________________________________________________________________ *SEE INSTRUCTIONS BEFORE FILLING OUT! - ----------- ** Includes an aggregate of 2,780 shares of common stock held as custodian for Dr. Cozean's two minor children. SEC 1746 (12-91) SCHEDULE 13G CUSIP No. 740522107 Page 3 of 5 Pages ITEM 1(a). NAME OF ISSUER. Premier Laser Systems, Inc. ITEM 1(b). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES. 3 Morgan Irvine, California 92618 ITEM 2(a). NAME OF PERSON FILING. Colette Cozean, Ph.D. ITEM 2(b). ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE. 3 Morgan Irvine, California 92618 ITEM 2(c). CITIZENSHIP. United States ITEM 2(d). TITLE OF CLASS OF SECURITIES. Class A, Class E-1 and Class E-2 Common Stock ITEM 2(e). CUSIP NUMBER. 740522107 ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO SS. 240.13D-1(b) OR SS. 240.13D-2(b) OR (c), CHECK WHETHER THE PERSON FILING IS A: NOT APPLICABLE (a) |_| Broker or Dealer registered under Section 15 of the Act; (b) |_| Bank as defined in section 3(a)(6) of the Act; (c) |_| Insurance Company as defined in section 3(a)(19) of the Act; (d) |_| Investment Company registered under section 8 of the Investment Company Act of 1940; (e) |_| An investment adviser in accordance with ss. 240.13d- 1(b)(1)(ii)(F); CUSIP No. 740522107 Page 4 of 5 Pages (f) |_| An employee benefit plan or endowment fund in accordance with ss. 240.13d-1(b)(1)(ii)(G); (g) |_| A parent holding company or control person in accordance with ss.240.13d-1(b)(1)(ii)(G); (h) |_| A savings association as defined in section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813); (i) |_| A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act; (j) |_| Group, in accordance with ss.240.13d-1(b)(1)(ii)(J). ITEM 4. OWNERSHIP Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in item 1. (a) Amount Beneficially Owned: 1,007,820 SHARES OF COMMON STOCK** (b) Percent of Class: 5.3% (c) Number of shares as to which such person has: (i) Sole power to vote or to direct the vote 1,007,820 SHARES OF COMMON STOCK** (ii) Shared power to vote or to direct the vote NOT APPLICABLE (iii) Sole power to dispose or to direct the disposition of 1,007,820 SHARES OF COMMON STOCK** (iv) Shared power to dispose or to direct the disposition of NOT APPLICABLE ** Includes an aggregate of 2,780 shares of common stock held as custodian for Dr. Cozean's two minor children. CUSIP No. 740522107 Page 5 of 5 Pages ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS. If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following [ ]. ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON. Not Applicable ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY. Not Applicable ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP. Not Applicable ITEM 9. NOTICE OF DISSOLUTION OF GROUP. Not Applicable ITEM 10. CERTIFICATION. By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect. SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. 10/22/99 --------------------------- Date /s/ COLETTE COZEAN --------------------------- Signature Colette Cozean, Ph.D., Chief Executive Officer ---------------------------------------------- Name/Title -----END PRIVACY-ENHANCED MESSAGE-----