-----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, SQ62IAn0r9jtiTw8yYv1G4jOvThYiOr1nmONg57qtLc9l02Oanp4v6AVeG3HKU5g 5VHNRmqVyNMy26kfxWhpxQ== 0001017062-97-000294.txt : 19970223 0001017062-97-000294.hdr.sgml : 19970223 ACCESSION NUMBER: 0001017062-97-000294 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970221 SROS: NONE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: UROGEN CORP CENTRAL INDEX KEY: 0001003929 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 330687976 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-50201 FILM NUMBER: 97541381 BUSINESS ADDRESS: STREET 1: 3099 SCIENCE PARK RD STREET 2: STE A CITY: SAN DIEGO STATE: CA ZIP: 92121 BUSINESS PHONE: 6194505949 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: PAYNE FAMILY TRUST CENTRAL INDEX KEY: 0001034246 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 21 RITZ COVE DRIVE CITY: DANA POINT STATE: CA ZIP: 92629 BUSINESS PHONE: 7142488670 SC 13G 1 SCHEDULE 13G FOR PAYNE FAMILY TRUST DTD 01/23/85 --------------------------- OMB APPROVAL --------------------------- OMB number: XXXX-XXXX Expires: XXXXXXX XX, 1994 Estimated average burden hours per response... 14.90 --------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13G UNDER THE SECURITIES EXCHANGE ACT OF 1934 (AMENDMENT NO. X )* ----- UroGen Corp. ------------------------------------------------------------- (Name of Issuer) Common Stock --------------------------------------------------- (Title of Class of Securities) None ----------------------------------------- (CUSIP Number) Check the following box if a fee is being paid with this statement [_]. (A fee is not required only if the filing person: (1) has a previous statement on file reporting beneficial ownership of more than five percent of the class of securities described in Item 1; and (2) has filed no amendment subsequent thereto reporting beneficial ownership of five percent or less of such class.) (See Rule 13d-7). *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 the disclosures provided in a prior cover page. The information required in 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). Page 1 of 3 Pages - ----------------------- --------------------- CUSIP NO. XXXXXXXXX 13G PAGE 2 OF 4 PAGES - ----------------------- --------------------- - ------------------------------------------------------------------------------ NAME OF REPORTING PERSON 1 S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON PAYNE FAMILY TRUST DTD JAN 23, 85 - ------------------------------------------------------------------------------ CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* 2 (a) [_] (b) [_] - ------------------------------------------------------------------------------ SEC USE ONLY 3 - ------------------------------------------------------------------------------ CITIZENSHIP OR PLACE OF ORGANIZATION 4 USA - ------------------------------------------------------------------------------ SOLE VOTING POWER 5 NUMBER OF 459,059 SHARES ----------------------------------------------------------- SHARED VOTING POWER BENEFICIALLY 6 OWNED BY ----------------------------------------------------------- EACH SOLE DISPOSITIVE POWER 7 REPORTING PERSON ----------------------------------------------------------- SHARED DISPOSITIVE POWER WITH 8 - ------------------------------------------------------------------------------ AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 9 459,059 - ------------------------------------------------------------------------------ CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* 10 - ------------------------------------------------------------------------------ PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 11 7.7% - ------------------------------------------------------------------------------ TYPE OF REPORTING PERSON* 12 TRUST - ------------------------------------------------------------------------------ *SEE INSTRUCTION BEFORE FILLING OUT! Page 2 of 3 pages Page 3 SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 Schedule 13G Under the Securities Exchange Act of 1934 Fee enclosed [_] or Amendment No. [_] Item 1(a) Name of Issuer: URoGen Corp. Item 1(b) Address of Issuer's Principal Executive Offices: Item 2(a) Name of Person(s) Filing: PAYNE FAMILY TRUST DTD JAN 23, 85 Item 2(b) Address of Principal Business Office: DANA POINT, CA 92629 Item 2(c) Citizenship: USA Item 2(d) Title of Class of Securities: Item 2(e) CUSIP Number: 917271 108 Item 3 The person(s) filing is(are): (b) [_] Bank as defined in Section 3(a)(6) of the Act. (e) [_] Investment Adviser registered under Section 203 of the Investment Advisers Act of 1940. (g) [_] Parent Holding Company in accordance with Section 240.13d-1(b)(1)(ii)(G). Item 4 Ownership (a) Amount Beneficially Owned: 459,059 (b) Percent of Class: 7.7% (c) Number of shares as to which such person has: Item 5 Ownership of 5% or Less of a Class: 0 Item 6 Ownership of More than 5% on Behalf of Another Person: 0 Item 7 Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company 0 Item 8 Identification and Classification of Members of the Group: 0 Item 9 Notice of Dissolution of the Group: 0 Item 10 Certification By signing below, I certify that, to the best of my knowledge and belief, the securities referred to above were acquired in the ordinary course of business and were not acquired for the purpose of and do not have the effect of changing or influencing the control of the issuer of such securities and were not acquired in connection with or as a participant in any transaction having such 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. Date: February 21, 1997 Signature: /s/ Errol Payne ---------------------------------------------- Name/Title: Trustee ---------------------------------------------- Payne Family Trust ----------------------------------------------- Date: December 7, 1993 Signature: /s/ ---------------------------------------------- Name/Title: ---------------------------------------------- ---------------------------------------------- -----END PRIVACY-ENHANCED MESSAGE-----