<PAGE>
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. )
-------
Physiometrix, Inc.
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(Name of Issuer)
Common Stock
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(Title of Class of Securities)
718928 10 4
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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 reporting 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 more than five percent or
less of such class.) (See Rue 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
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).
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CUSIP No. 718928 10 4 Page 2 of 12
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1. NAME OF REPORTING PERSON
S.S. OR I.R.S IDENTIFICATION NO. OF ABOVE PERSON
Technology Funding Venture Partners IV, An Aggressive Growth Fund, L.P.
- ------------------------------------------------------------------------------
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(A) ( )
(B) ( X )
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
Delaware
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NUMBER OF 5 SOLE VOTING POWER 270,791
SHARES --------------------------------------------------
BENEFICIALLY 6 SHARED VOTING POWER 0
OWNED BY -------------------------------------------------
EACH 7 SOLE DISPOSITIVE POWER 270,791
REPORTING -------------------------------------------------
PERSON WITH 8 SHARED DISPOSITIVE POWER 0
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH PERSON
270,791
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES*
( )
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
4.8%
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12 TYPE OF REPORTING PERSON*
PN
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CUSIP No. 718928 10 4 Page 3 of 12
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1. NAME OF REPORTING PERSON
S.S. OR I.R.S IDENTIFICATION NO. OF ABOVE PERSON
Technology Funding Venture Partners V, An Aggressive Growth Fund, L.P.
- ------------------------------------------------------------------------------
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(A) ( )
(B) ( X )
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3 SEC USE ONLY
- ------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
Delaware
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NUMBER OF 5 SOLE VOTING POWER 300,546
SHARES --------------------------------------------------
BENEFICIALLY 6 SHARED VOTING POWER 0
OWNED BY -------------------------------------------------
EACH 7 SOLE DISPOSITIVE POWER 300,546
REPORTING -------------------------------------------------
PERSON WITH 8 SHARED DISPOSITIVE POWER 0
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH PERSON
300,546
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES*
( )
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
5.3%
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12 TYPE OF REPORTING PERSON*
PN
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<PAGE>
CUSIP No. 718928 10 4 Page 4 of 12
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1. NAME OF REPORTING PERSON
S.S. OR I.R.S IDENTIFICATION NO. OF ABOVE PERSON
Technology Funding Inc.
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(A) ( )
(B) ( X )
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
California
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NUMBER OF 5 SOLE VOTING POWER 0
SHARES --------------------------------------------------
BENEFICIALLY 6 SHARED VOTING POWER 571,337
OWNED BY --------------------------------------------------
EACH 7 SOLE DISPOSITIVE POWER 0
REPORTING --------------------------------------------------
PERSON WITH 8 SHARED DISPOSITIVE POWER 571,337
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH PERSON
571,337
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES*
( )
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
10.2%
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12 TYPE OF REPORTING PERSON*
IA,CO
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<PAGE>
CUSIP No. 718928 10 4 Page 5 of 12
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1. NAME OF REPORTING PERSON
S.S. OR I.R.S IDENTIFICATION NO. OF ABOVE PERSON
Technology Funding Ltd.
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(A) ( )
(B) ( X )
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3 SEC USE ONLY
- ------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
California
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NUMBER OF 5 SOLE VOTING POWER 0
SHARES --------------------------------------------------
BENEFICIALLY 6 SHARED VOTING POWER 571,337
OWNED BY --------------------------------------------------
EACH 7 SOLE DISPOSITIVE POWER 0
REPORTING -------------------------------------------------
PERSON WITH 8 SHARED DISPOSITIVE POWER 571,337
- ------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH PERSON
571,337
- ------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES*
( )
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
10.2%
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12 TYPE OF REPORTING PERSON*
IA,PN
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<PAGE>
CUSIP No. 718928 10 4 Page 6 of 12
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1. NAME OF REPORTING PERSON
S.S. OR I.R.S IDENTIFICATION NO. OF ABOVE PERSON
Charles R. Kokesh
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(A) ( )
(B) ( X )
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
U.S. Citizen
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NUMBER OF 5 SOLE VOTING POWER 0
SHARES --------------------------------------------------
BENEFICIALLY 6 SHARED VOTING POWER 571,337
OWNED BY --------------------------------------------------
EACH 7 SOLE DISPOSITIVE POWER 0
REPORTING -------------------------------------------------
PERSON WITH 8 SHARED DISPOSITIVE POWER 571,337
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH PERSON
571,337
- ------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES*
( )
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
10.2%
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12 TYPE OF REPORTING PERSON*
HC,IN
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<PAGE>
CUSIP No. 718928 10 4 Page 7 of 12
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1. NAME OF REPORTING PERSON
S.S. OR I.R.S IDENTIFICATION NO. OF ABOVE PERSON
Gregory T. George
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(A) ( )
(B) ( X )
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
U.S. Citizen
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NUMBER OF 5 SOLE VOTING POWER 0
SHARES --------------------------------------------------
BENEFICIALLY 6 SHARED VOTING POWER 571,337
OWNED BY -------------------------------------------------
EACH 7 SOLE DISPOSITIVE POWER 0
REPORTING -------------------------------------------------
PERSON WITH 8 SHARED DISPOSITIVE POWER 571,337
- ------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH PERSON
571,337
- ------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES*
( )
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
10.2%
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12 TYPE OF REPORTING PERSON*
HC,IN
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<PAGE>
CUSIP No. 718928 10 4 Page 8 of 12
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1. NAME OF REPORTING PERSON
S.S. OR I.R.S IDENTIFICATION NO. OF ABOVE PERSON
Thomas J. Toy
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(A) ( )
(B) ( X )
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
U.S Citizen
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NUMBER OF 5 SOLE VOTING POWER 0
SHARES --------------------------------------------------
BENEFICIALLY 6 SHARED VOTING POWER 571,337
OWNED BY --------------------------------------------------
EACH 7 SOLE DISPOSITIVE POWER 0
REPORTING --------------------------------------------------
PERSON WITH 8 SHARED DISPOSITIVE POWER 571,337
- ------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH PERSON
571,337
- ------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES*
( )
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
10.2%
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12 TYPE OF REPORTING PERSON*
HC,IN
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<PAGE>
CUSIP No. 718928 10 4 Page 9 of 12
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1. NAME OF REPORTING PERSON
S.S. OR I.R.S IDENTIFICATION NO. OF ABOVE PERSON
Peter F. Bernardoni
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(A) ( )
(B) ( X )
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
U.S. Citizen
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NUMBER OF 5 SOLE VOTING POWER 0
SHARES --------------------------------------------------
BENEFICIALLY 6 SHARED VOTING POWER 571,337
OWNED BY --------------------------------------------------
EACH 7 SOLE DISPOSITIVE POWER 0
REPORTING --------------------------------------------------
PERSON WITH 8 SHARED DISPOSITIVE POWER 571,337
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH PERSON
571,337
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10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW 9 EXCLUDES CERTAIN SHARES*
( )
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
10.2%
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12 TYPE OF REPORTING PERSON*
HC,IN
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<PAGE>
CUSIP No. 718928 10 4
Page 10 of 12
Item 1 (a) Name of Issuer: Physiometrix, Inc.
---------------
Item 1 (b) Address of Issuer's Principal Executive Offices:
------------------------------------------------
101 Billerica Avenue, North Billerica, Massachusetts 01862-1256
Item 2 (a) Name of Person Filing:
----------------------
The information contained in Item ( 1 ) of the cover pages hereof
(Pages 2 through 9) is incorporated herein by this reference.
Item 2 (b) Address of Principal Business Office or, if none, Residence:
------------------------------------------------------------
The Principal business office of each person filing is located at
2000 Alameda de las Pulgas, San Mateo, CA 94403
Item 2 (c) Citizenship:
--------------
Each person filing who is identified on the cover pages hereof as an
individual is a United States citizen.
Item 2 (d) Title of Class of Securities:
-----------------------------
Common Stock
Item 2 (e) CUSIP Number: 718928 10 4
-------------
Item 3. Classification: Inapplicable.
---------------
Item 4. Ownership.
----------
The information contained in Items (5), (6), (7), (8), (9) and (11)
of the cover pages hereof (pages 2 through 9) is incorporated herein
by this reference. Technology Funding Inc. and Technology Funding
Ltd. are the general partners of the limited partnerships that are
the direct beneficial owners of the securities being reported on. The
individual reporting persons are general partners of Technology
Funding Ltd. and/or officers of Technology Funding Inc.
Item 5. Ownership of Five Percent or Less of a Class.
---------------------------------------------
Inapplicable.
Item 6. Ownership of More than Five Percent on Behalf of Another Person.
----------------------------------------------------------------
Inapplicable.
Item 7. Identification and Classification of the Subsidiary which acquired
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the Security being reported on by the Parent Holding Company.
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Inapplicable.
Item 8. Identification and Classification of Members of the Group.
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Inapplicable.
Item 9. Notice of Dissolution of Group.
-------------------------------
Inapplicable.
Item 10. Certification.
--------------
Inapplicable.
<PAGE> Page 11 of 12
SIGNATURE(S)
- ------------
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.
Dated: February 13, 1997 TECHNOLOGY FUNDING VENTURE PARTNERS IV,
AN AGGRESSIVE GROWTH FUND, L.P.,
a Delaware Limited Partnership
By: TECHNOLOGY FUNDING INC.,
Managing General Partner
By: /s/ Charles R. Kokesh
-----------------------------------
Charles R. Kokesh
Chief Executive Officer,
by Thomas J. Toy his
Attorney-in-Fact
Dated: February 13, 1997 TECHNOLOGY FUNDING VENTURE PARTNERS V,
AN AGGRESSIVE GROWTH FUND, L.P.,
a Delaware Limited Partnership
By: TECHNOLOGY FUNDING INC.,
Managing General Partner
By: /s/ Charles R. Kokesh
-----------------------------------
Charles R. Kokesh
Chief Executive Officer,
by Thomas J. Toy his
Attorney-in-Fact
Dated: February 13, 1997 TECHNOLOGY FUNDING INC.,
a California Corporation
By: /s/ Charles R. Kokesh
-----------------------------------
Charles R. Kokesh
Executive Vice President,
by Thomas J. Toy his
Attorney-in-Fact
Dated: February 13, 1997 TECHNOLOGY FUNDING LTD.,
a California Limited Partnership
By: /s/ Charles R. Kokesh
-----------------------------------
Charles R. Kokesh
General Partner, by Thomas J. Toy
his Attorney-in-Fact
Dated: February 13, 1997 /s/ Charles R. Kokesh
------------------------------------
Charles R. Kokesh by Thomas J. Toy
his Attorney-in-Fact
Dated: February 13, 1997 /s/ Gregory T. George
------------------------------------
Gregory T. George by Thomas J. Toy
his Attorney-in-Fact
Dated: February 13, 1997 /s/ Thomas J. Toy
------------------------------------
Thomas J. Toy
Dated: February 13, 1997 /s/ Peter F. Bernardoni
-------------------------------------
Peter F. Bernardoni by Thomas J. Toy
his Attorney-in-Fact
The Powers of Attorney previously filed with the Commission and appointing Mr.
Thomas J. Toy as attorney-in-fact for Messrs. Kokesh, George, and Bernardoni
are hereby incorporated herein by this reference.
<PAGE>
Page 12 of 12
AGREEMENT
- ---------
This will memorialize the agreement by and among all of the undersigned that
the Schedule 13G identifying each of the undersigned as "reporting persons"
and mailed to Physiometrix, Inc. and filed with the Securities and Exchange
Commission on or about February 13, 1997 with respect to the beneficial
ownership of shares of Physiometrix's Common Stock is being filed on behalf of
each of the persons signing below. This Agreement may be executed in
counterparts, each of which shall be deemed an original, but all of which
together shall constitute one and the same instrument.
Dated: February 13, 1997 TECHNOLOGY FUNDING VENTURE PARTNERS IV,
AN AGGRESSIVE GROWTH FUND, L.P.,
a Delaware Limited Partnership
By: TECHNOLOGY FUNDING INC.,
Managing General Partner
By: /s/ Charles R. Kokesh
-----------------------------------
Charles R. Kokesh
Chief Executive Officer,
by Thomas J. Toy his
Attorney-in-Fact
Dated: February 13, 1997 TECHNOLOGY FUNDING VENTURE PARTNERS V,
AN AGGRESSIVE GROWTH FUND, L.P.,
a Delaware Limited Partnership
By: TECHNOLOGY FUNDING INC.,
Managing General Partner
By: /s/ Charles R. Kokesh
-----------------------------------
Charles R. Kokesh
Chief Executive Officer,
by Thomas J. Toy his
Attorney-in-Fact
Dated: February 13, 1997 TECHNOLOGY FUNDING INC.,
a California Corporation
By: /s/ Charles R. Kokesh
-----------------------------------
Charles R. Kokesh
Executive Vice President,
by Thomas J. Toy his
Attorney-in-Fact
Dated: February 13, 1997 TECHNOLOGY FUNDING LTD.,
a California Limited Partnership
By: /s/ Charles R. Kokesh
-----------------------------------
Charles R. Kokesh
General Partner, by Thomas J. Toy
his Attorney-in-Fact
Dated: February 13, 1997 /s/ Charles R. Kokesh
------------------------------------
Charles R. Kokesh by Thomas J. Toy
his Attorney-in-Fact
Dated: February 13, 1997 /s/ Gregory T. George
------------------------------------
Gregory T. George by Thomas J. Toy
his Attorney-in-Fact
Dated: February 13, 1997 /s/ Thomas J. Toy
------------------------------------
Thomas J. Toy
Dated: February 13, 1997 /s/ Peter F. Bernardoni
------------------------------------
Peter F. Bernardoni by Thomas J. Toy
his Attorney-in-Fact
