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SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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FORM 8-A
For Registration of Certain Classes of Securities
Pursuant to Section 12(b) or 12(g) of the
Securities Exchange Act of 1934
PATIENT INFOSYSTEMS, INC.
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(Exact name of registrant as specified in its charter)
Delaware 16-1476509
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(State of incorporation or organization) (I.R.S. Employee Identification No.)
46 Prince Street, Rochester, New York 14607
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(Address of principal executive offices) (zip code)
Securities to be registered pursuant to Section 12(b) of the Act:
Title of each class Name of each exchange on which
to be so registered each class is to be registered
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Securities to be registered pursuant to Section 12(g) of the Act:
Common Stock $.01 par value
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(Title of Class)
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(Title of Class)
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INFORMATION REQUIRED IN REGISTRATION STATEMENT
Item I. Description of Registrant's Securities to be Registered.
The information called for by this Item 1 is incorporated herein
by reference to the Registrant's Prospectus to be filed with the Securities
and Exchange Commission pursuant to Rule 424(b) of the Securities Act of
1933, as amended.
Item 2. Exhibits.
1. Specimen of certificate evidencing Registrant's Common
Stock, par value $.01.*
2. (a) Certificate of Incorporation, as amended, of the
Registrant.+
(b) By-Laws of the Registrant.+
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* Filed as an exhibit to Amendment No. 4 to the Registrant's Registration
Statement on Form S-1 (File No. 333-07643).
+ Filed as an exhibit to the Registrant's Registration Statement on Form
S-1 (File No. 333-07643) filed with the Commission on July 3, 1996.
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SIGNATURE
Pursuant to the requirements of Section 12 of the Securities Exchange
Act of 1934, the Registrant has duly caused this Registration Statement to be
signed on its behalf by the undersigned, thereto duly authorized.
PATIENT INFOSYSTEMS, INC.
By: /s/ Donald A. Carlberg
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Donald A. Carlberg,
President and Chief Executive Officer
Dated: December 16, 1996
