X0202 3 2006-01-25 0 0001017813 PATIENT INFOSYSTEMS INC PATY 0001351553 HICKORY VENTURE CAPITAL CORP 301 WASHINGTON STREET, NW SUITE 301 HUNTSVILLE AL 35801 0 0 1 0 Common Stock 8213370 D Common Stock 577652 I By Fund through escrow Common Stock 94707 I By Fund through escrow Call Option Equivalent (obligation to sell) 0 2006-01-25 2007-07-25 Common Stock 94707 I By Fund through escrow Represents shares held in escrow for the benefit of former stockholders of CCS Consolidated, Inc. whose shares were converted into shares of the Issuer as a result of a merger between CCS Consolidated, Inc. and the Issuer. The reported number of shares represents the minimum number of shares issuable to the Reporting Person upon termination of the escrow arrangement and liquidation of the escrow account. In addition, the Reporting Person holds a warrant which may entitle it to purchase additional shares currently held in the escrow account, subject to the terms thereof. Because the number of shares exercisable under the warrant held by the Reporting Person is not fixed, the warrant is not reportable as a derivative security on this Form 3. To the extent that the warrant becomes exercisable, the Reporting Person will file a Form 4 reflecting the acquisition of a derivative security. Represents shares held in escrow for the benefit of another stockholder of the Issuer. The number of shares to be released to the other stockholder is contingent upon the occurrence of certain events as described in a letter agreement between the Issuer and the other stockholder. The reported number of shares represents the maximum number of shares issuable to the Reporting Person upon termination of the escrow arrangement and liquidation of the escrow account. These shares are subject to a call option in favor of the other stockholder as described in footnote (3). Another stockholder of the Issuer may, contingent upon the occurrence of certain events not in the control of the Reporting Person or the other stockholder, acquire the entire amount of the stock held in escrow as described in footnote (3), including the shares reported by the Reporting Person. No additional consideration will be received by the Reporting Person to the extent the call option on these shares is exercised by the other stockholder. To the extent that the shares held in escrow may not be distributed to the other stockholder, the Reporting Person will report the partial or full expiration of the call option on Form 4. /s/ J. Thomas Noojin, President 2006-02-02