-----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, SNAL1zkgdk2VezDbU7tGdgZBePUAAc67egDZnZd+f9KIIogwnDmP7ejtO0f53agd o9dwWH82GJQ4VSGp7uMO+w== 0000897464-04-000001.txt : 20040220 0000897464-04-000001.hdr.sgml : 20040220 20040220114646 ACCESSION NUMBER: 0000897464-04-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031221 FILED AS OF DATE: 20040220 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PATIENT INFOSYSTEMS INC CENTRAL INDEX KEY: 0001017813 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 161476509 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 46 PRINCE ST CITY: ROCHESTER STATE: NY ZIP: 14607 BUSINESS PHONE: 5852427200 MAIL ADDRESS: STREET 1: 46 PRINCE ST CITY: ROCHESTER STATE: NY ZIP: 14607 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PAPPAJOHN JOHN CENTRAL INDEX KEY: 0000897464 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22319 FILM NUMBER: 04618296 BUSINESS ADDRESS: STREET 1: C/O EQUITY DYNAMICS STREET 2: 2116 FINANCIAL CENTER CITY: DES MOINES STATE: IA ZIP: 50309 BUSINESS PHONE: 3034470248 MAIL ADDRESS: STREET 1: 2116 FINANCIAL CENTER STREET 2: C/O EQUITY DYNAMICS CITY: DES MOINES STATE: IA ZIP: 50309 4 1 primary_doc.xml PRIMARY DOCUMENT X0201 4 2003-12-21 0 0001017813 PATIENT INFOSYSTEMS INC PATY 0000897464 PAPPAJOHN JOHN 2116 FINANCIAL CENTER C/O EQUITY DYNAMICS DES MOINES IA 50309 1 0 1 0 Common Stock 2003-12-31 4 P 0 2706604 1.68 A 2930060 D Common Stock 2003-12-31 4 G 0 165000 0 D 2765060 D Common Stock 30000 I By Halkis, Ltd. Common Stock 30000 I By Spouse Common Stock 30000 I By Thebes, Ltd. Option (right to buy) 8.33 2005-08-25 Common Stock 3000 3000 D Warrant (right to buy) 10 2003-12-21 4 J 0 28220 0 A 2008-12-21 Common Stock 282200 28220 D Series C Convertible Preferred 10 2003-12-31 4 G 0 22500 0 D Common Stock 225000 27500 D Series D Convertible Preferred 10 2003-12-31 4 P 0 188724 5.32 A Common Stock 1887240 188724 D Series D Convertible Preferred 10 2004-01-30 4 J 0 151475 10 A Common Stock 1514750 424206 D On June 11, 2002, the board of directors of Patient Infosystems, Inc. approved the issuance of these shares of common stock in exchange for the cancellation of outstanding promissory notes and accrued interest. Securities issued in connection with debt-guaranty extension. Immediately Exercisable No expiration date Received in connection with the mandatory conversion of accrued interest payable on promissory notes to Series D Preferred Convertible Stock. John Pappajohn 2004-02-20 -----END PRIVACY-ENHANCED MESSAGE-----