X0202 4 2006-01-25 0 0001017813 PATIENT INFOSYSTEMS INC PATY 0000897464 PAPPAJOHN JOHN C/O EQUITY DYNAMICS 2116 FINANCIAL CENTER DES MOINES IA 50309 1 0 1 0 Common Stock 2006-01-25 2006-01-25 4 C 0 110000 1.00 A 3909237 D Common Stock 2006-01-25 2006-01-25 4 C 0 4473220 1.00 A 8382457 D Common Stock 2006-01-25 2006-01-25 4 Z 0 1666936 D 6715521 I Voting Trust Series C Preferred 2006-01-25 2006-01-25 4 C 0 11000 10.00 D Common 110000 0 D Series D Preferred 2006-01-25 2006-01-25 4 C 0 447322 10.00 D Common 4473220 0 D Option 3.08 2006-01-25 2006-01-25 4 H 0 50000 3.08 D 2004-11-17 2006-01-25 Common 50000 0 D Warrants 0.95 2006-01-25 2006-01-25 4 A 0 37500 0.95 A 2006-01-25 2009-01-25 Common 37500 37500 D Conversion of Series C Convertible Preferred Stock into Common Stock Conversion of Series D Convertible Preferred Stock into Common Stock Cancellation of option to purchase Common Stock in exchange for a warrant to purchase Common Stock Deposited 1,666,936 shares held into a voting trust John Pappajohn 2006-01-27