-----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, PAzfRSuMlvlK8mkeSmc22HpZqe1HGl6UWTMS4tMS6F4soFVcxitDpRgsvP2+ys1L YcV6JAyRt4kKX/70/cv6hg== 0001030336-97-000003.txt : 19970227 0001030336-97-000003.hdr.sgml : 19970227 ACCESSION NUMBER: 0001030336-97-000003 CONFORMED SUBMISSION TYPE: SC 13G CONFIRMING COPY: PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970226 SROS: NASD 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 SEC ACT: 1934 Act SEC FILE NUMBER: 005-50085 FILM NUMBER: 00000000 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: GORDON MANAGEMENT INC /FA CENTRAL INDEX KEY: 0001030336 STANDARD INDUSTRIAL CLASSIFICATION: [] IRS NUMBER: 421380846 STATE OF INCORPORATION: IA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: P O BOX 1491 CITY: DES MOINES STATE: IA ZIP: 50306 BUSINESS PHONE: 5152455666 MAIL ADDRESS: STREET 1: PO BOX 1491 CITY: DES MOINES STATE: IA ZIP: 50306 SC 13G 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. )* Patient InfoSystems (Name of Issuer) Common Stock, $.01 par value per share (Title of Class Securities) 702915109 (CUSIP Number) *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.: 702915109 1) Names of Reporting Persons, S.S. or I.R.S. Identification Nos. of Above Person: Edgewater Private Equity Fund II, L.P. 42-1446140 2) Check the appropriate Box if a Member of a Group N/A 3) SEC Use Only 4) Citizenship or Place of Organization United States Number of Shares Beneficially Owned by Each Reporting Person 5) Sole Voting Power: 970,000 shares 6) Shared Voting Power: -0- Shares 7) Sole Dispositive Power: 970,000 Shares 8) Shared Dispositive Power: -0- Shares 9) Aggregate Amount Beneficially Owned by Each Reporting Person 970,000 Shares 10) Check if the Aggregate Amount in Row (9) Excludes Certain Shares [ ] 11) Percent of Class Represented by Amount in Row 9 12.2% 12) Type of Reporting Person PN Item 1 (a) Name of Issuer: Patient InfoSystems Item 1 (b) Address of Issuer's Principal Executive Offices: 46 Prince Street, Rochester, New York 14607 Item 2 (a) Name of Person Filing: Edgewater Private Equity Fund II, L.P. Item 2 (b) Address of Principal Business Office, or, if none, Residence: 666 Grand Avenue, Suite 200, Des Moines, IA 50309 Item 2 (c ) Citizenship: Iowa Item 2 (d) Title of Class of Securities: Common Stock, $.01 par value Item 2 (e) CUSIP Number: 702915109 Item 3 Not applicable. Item 4 Ownership: The following information is provided as of December 31, 1996: (a) Amount Beneficially owned: 970,000 shares. (b) Percent of Class: 12.2% (c ) Undersigned has sole power to vote 970,000 shares. Item 5 Ownership of Five Percent or Less of a Class: [ ] 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. January 31, 1997 ------------------------------------- Date Edgewater Private Equity Fund, II L.P. by:_/s/_James A. Gordon James A. Gordon, General Partner -----END PRIVACY-ENHANCED MESSAGE-----