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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(AMENDMENT NO. X )*
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UroGen Corp.
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(Name of Issuer)
Common Stock
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(Title of Class of Securities)
None
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(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
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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
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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
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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.
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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
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Name/Title: Trustee
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Payne Family Trust
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Date: December 7, 1993
Signature: /s/
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Name/Title:
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