-----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, DckteeYLEl1XD0jMSuxmjImMtftx7PT8EUI1tZ+htleJCRBt+fT0jFkHoafgqlGF dDP/I21VIVrJDK6Giet6/A== 0001005477-00-000760.txt : 20000211 0001005477-00-000760.hdr.sgml : 20000211 ACCESSION NUMBER: 0001005477-00-000760 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20000210 SUBJECT COMPANY: 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 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: SEC FILE NUMBER: 005-50085 FILM NUMBER: 530837 BUSINESS ADDRESS: STREET 1: 46 PRINCE ST CITY: ROCHESTER STATE: NY ZIP: 14607 BUSINESS PHONE: 7162427200 MAIL ADDRESS: STREET 1: 46 PRINCE ST CITY: ROCHESTER STATE: NY ZIP: 14607 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: PAPPAJOHN JOHN CENTRAL INDEX KEY: 0000897464 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: C/O EQUITY DYNAMICS STREET 2: 2116 FINANCIAL CENTER CITY: DES MOINES STATE: IA ZIP: 50309 MAIL ADDRESS: STREET 1: 2116 FINANCIAL CENTER STREET 2: C/O EQUITY DYNAMICS CITY: DES MOINES STATE: IA ZIP: 50309 SC 13G/A 1 AMENDMENT NUMBER 1 TO SCHEDULE 13G SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G/A Rule 13d-102 Under the Securities Exchange Act of 1934 (Amendment No. 1)* Patient Infosystems, Inc. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock - -------------------------------------------------------------------------------- (Title of Class of Securities) 878190 11 5 - -------------------------------------------------------------------------------- (CUSIP Number) - -------------------------------------------------------------------------------- (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) |_| Rule 13d-1 (c) |X| 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). CUSIP No. 13G Page of - -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON John Pappajohn - -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) |_| (b) |_| Not applicable - -------------------------------------------------------------------------------- 3 SEC USE ONLY - -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States - -------------------------------------------------------------------------------- 5 SOLE VOTING POWER 881,280 shares** -------------------------------------------------------------- NUMBER OF 6 SHARED VOTING POWER SHARES BENEFICIALLY 720,000 shares*** OWNED BY -------------------------------------------------------------- EACH 7 SOLE DISPOSITIVE POWER REPORTING PERSON 881,280 shares** WITH -------------------------------------------------------------- 8 SHARED DISPOSITIVE POWER 720,000 shares*** - -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,601,280 shares - -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 19.9% - -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* IN - -------------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT ** Includes 360,000 shares held by Halkis, Ltd., a sole proprietorship owned by Mr. Pappajohn, and options to purchase 28,800 shares which are currently exercisable. Does not include 7,200 shares subject to outstanding options which are not exercisable within the next 60 days. *** Includes 360,000 shares held by Thebes, Ltd., a sole proprietorship owned by Mr. Pappajohn's spouse, and 360,000 shares held directly by Mr. Pappajohn's spouse. Mr. Pappajohn disclaims beneficial ownership of the shares owned by Thebes, Ltd. and by his spouse. CUSIP No. 878190 11 5 Item 1. (a) Name of Issuer: Patient Infosystems, Inc. (b) Address of Issuer's Principal Executive Offices: 46 Prince Street Rochester, New York 14607 Item 2. (a) Name of Person Filing: John Pappajohn (b) Address of Principal Business Office or, if none, Residence: c/o Equity Dynamics 2116 Financial Center Des Moines, Iowa 50309 (c) Citizenship: United States (d) Title of Class of Securities: Common Stock (e) CUSIP Number: 878190 11 5 Item 3. If this statement is filed pursuant to Rule 13d-1(b), or 13d-2(b), 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 (e) [ ] Investment Adviser registered under section 203 of the Investment Advisers Act of 1940 CUSIP No. 878190 11 5 (f) [ ] Employee Benefit Plan, Pension Fund which is subject to the provisions of the Employee Retirement Income Security Act of 1974 or Endowment Fund; see ss.240.13d-1(b)(1)(ii)(F) (g) [ ] Parent Holding Company, in accordance with ss.240.13d-1(b)(ii)(G) (Note: See Item 7) (h) [ ] Group, in accordance with ss.240.13d-1(b)(1)(ii)(H) Item 4. Ownership (a) Amount Beneficially Owned: 1,601,280 shares (b) Percent of Class: 19.9% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote: 881,280 shares** (ii) shared power to vote or to direct the vote: 720,000 shares*** (iii) sole power to dispose or to direct the disposition of: 881,280 shares** (iv) shared power to dispose or to direct the disposition of: 720,000 shares*** ** Includes 360,000 shares held by Halkis, Ltd., a sole proprietorship owned by Mr. Pappajohn, and options to purchase 28,800 shares which are currently exercisable. Does not include 7,200 shares subject to outstanding options which are not exercisable within the next 60 days. *** Includes 360,000 shares held by Thebes, Ltd., a sole proprietorship owned by Mr. Pappajohn's spouse and 360,000 shares held directly by Mr. Pappajohn's spouse. Mr. Pappajohn disclaims beneficial ownership of the shares owned by Thebes, Ltd. and by his spouse. Item 5. Ownership of Five Percent or Less of a Class Not Applicable CUSIP No. 878190 11 5 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 Not Applicable 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. February 9, 2000 - --------------------------------- Date /s/ John Pappajohn - --------------------------------- John Pappajohn -----END PRIVACY-ENHANCED MESSAGE-----