UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G
UNDER THE SECURITIES EXCHANGE ACT OF 1934
Urologix, Inc.
- --------------------------------------------------------------------------------
(Name of Issuer)
Common Stock
- --------------------------------------------------------------------------------
(Title of Class of Securities)
917273 10 4
- --------------------------------------------------------------------------------
(CUSIP Number)
*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 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
- --------------------------------------------- ------------------------------------
13G
CUSIP No. 917273 10 4 Page 2 of 14 Pages
------------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
InterWest Partners IV, a California limited partnership
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
California
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 701,474
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
0
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
701,474
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
0
- ----------------------------- -------- --------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
PN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 2 of 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
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13G
CUSIP No. 917273 10 4 Page 3 of 14 Pages
-----------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
InterWest Management Partners IV, L.P.
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
California
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 701,474
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
0
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
701,474
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
0
- ----------------------------- -------- --------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
PN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 3 of 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
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13G
CUSIP No. 917273 10 4 Page 4 of 14 Pages
-----------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
Harvey B. Cash
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
United States
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 0
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
701,474
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
0
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
701,474
- --------- -------------------------------------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
IN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 4 of 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
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13G
CUSIP No. 917273 10 4 Page 5 of 14 Pages
-----------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
Alan W. Crites
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
United States
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 0
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
701,474
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
0
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
701,474
- ----------------------------- -------- --------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
IN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 5 of 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
- --------------------------------------------- ------------------------------------
13G
CUSIP No. 917273 10 4 Page 6 of 14 Pages
-----------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
Philip T. Gianos
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
United States
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 0
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
701,474
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
0
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
701,474
- ----------------------------- -------- --------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
IN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 6 of 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
- --------------------------------------------- ------------------------------------
13G
CUSIP No. 917273 10 4 Page 7 of 14 Pages
-----------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
Wallace R. Hawley
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
United States
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 0
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
701,474
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
0
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
701,474
- --------- -------------------------------------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
IN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 7 of 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
- --------------------------------------------- ------------------------------------
13G
CUSIP No. 917273 10 4 Page 8 of 14 Pages
-----------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
W. Scott Hedrick
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
United States
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 0
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
701,474
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
0
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
701,474
- --------- -------------------------------------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
IN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 8 of 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
- --------------------------------------------- ------------------------------------
13G
CUSIP No. 917273 10 4 Page 9 of 14 Pages
-----------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
W. Stephen Holmes III
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
United States
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 0
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
701,474
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
0
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
701,474
- ----------------------------- -------- --------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
IN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 9 of 14 Pages
<PAGE>
<TABLE>
<S> <C> <C>
- --------------------------------------------- ------------------------------------
13G
CUSIP No. 917273 10 4 Page 10 of 14 Pages
-----------
- --------------------------------------------- ------------------------------------
- --------- -------------------------------------------------------------------------------------------------------------
1 NAME OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
Robert R. Momsen
- --------- -------------------------------------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
- --------- -------------------------------------------------------------------------------------------------------------
3 SEC USE ONLY
- --------- -------------------------------------------------------------------------------------------------------------
4 CITIZENSHIP OR PLACE OF ORGANIZATION
United States
- ----------------------------- -------- --------------------------------------------------------------------------------
5 SOLE VOTING POWER
NUMBER OF 0
-------- --------------------------------------------------------------------------------
SHARES 6 SHARED VOTING POWER
BENEFICIALLY OWNED BY
701,474
-------- --------------------------------------------------------------------------------
EACH REPORTING PERSON WITH 7 SOLE DISPOSITIVE POWER
0
-------- --------------------------------------------------------------------------------
8 SHARED DISPOSITIVE POWER
701,474
- ----------------------------- -------- --------------------------------------------------------------------------------
9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
701,474
- --------- -------------------------------------------------------------------------------------------------------------
10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
- --------- -------------------------------------------------------------------------------------------------------------
11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
- --------- -------------------------------------------------------------------------------------------------------------
12 TYPE OF REPORTING PERSON*
IN
- --------- -------------------------------------------------------------------------------------------------------------
<FN>
*SEE INSTRUCTION BEFORE FILLING OUT!
</FN>
</TABLE>
Page 10 of 14 Pages
<PAGE>
Item 1.
(a) Name of Issuer: Urologix, Inc. ("Issuer")
(b) Address of Issuer's Principal Executive Offices:
14405 Twenty-First Avenue North
Minneapolis, MN 55447
Item 2.
(a) Name of Person(s) Filing:
InterWest Partners IV, L.P., a California limited partnership ("IWP IV")
InterWest Management Partners IV, L.P. ("IMP IV")
Harvey B. Cash ("Cash")
Alan W. Crites ("Crites")
Philip T. Gianos ("Gianos")
Wallace R. Hawley ("Hawley")
W. Scott Hedrick ("Hedrick")
W. Stephen Holmes ("Holmes")
Robert R. Momsen ("Momsen")
(b) Address of Principal Business Office or, if none, Residence:
3000 Sand Hill Road
Building 3, Suite 255
Menlo Park, CA 94025
(c) Citizenship/Place of Organization:
IWP IV: California
IMP IV: California
Cash: United States
Crites: United States
Gianos: United States
Hawley: United States
Hedrick: United States
Holmes: United States
Momsen: United States
(d) Title of Class of Securities: Common Stock
(e) CUSIP Number: 917273 10 4
Item 3. Not applicable.
Page 11 of 14 Pages
<PAGE>
Item 4 Ownership.
========================================================
Each
Other
IWP IV IMP IV Individual
- --------------------------------------------------------
(a) Beneficial
Ownership 701,474 701,474 701,474
- --------------------------------------------------------
(b) Percentage
of Class 7.7% 7.7% 7.7%
- --------------------------------------------------------
(c) Sole Voting
Power 701,474 701,474 0
- --------------------------------------------------------
Shared Voting
Power 0 0 701,474
- --------------------------------------------------------
Sole
Dispositive
Power 701,474 701,474 0
- --------------------------------------------------------
Shared
Dispositive
Power 0 0 701,474
========================================================
Item 5. Ownership of Five Percent or Less of a Class
Not applicable.
Item 6. Ownership of More than Five Percent on Behalf of Another Person
Under certain circumstances set forth in the partnership agreement of IMP IV,
the general partners and/or limited partners of such partnership have the right
to receive dividends from, or the proceeds from the sale of, the Common Stock of
Issuer beneficially owned by such Partnership.
Item 7. Identification and Classification of the Subsidiary Which
Acquired the Security Being Reported on
By the Parent Holding Company.
Not applicable.
Item 8. Identification and Classification of Members of the Group
No reporting person is a member of a group as defined in section
240.13d-1(b)(1)(iii)(H) of the Act.
Item 9. Notice of Dissolution of Group
Not applicable.
Item 10. Certification
Not applicable
EXHIBITS
A. Joint Filing Statement
Page 12 of 14 Pages
<PAGE>
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 ____, 1997
INTERWEST PARTNERS IV, L.P., a California ------------------------------
limited partnership Harvey B. Cash
By: InterWest Management Partners IV, L.P. ------------------------------
Alan W. Crites
By:
--------------------------------- ------------------------------
General Partner Philip T. Gianos
INTERWEST MANAGEMENT PARTNERS IV, L.P. ------------------------------
Wallace R. Hawley
By:
--------------------------------- ------------------------------
General Partner W. Scott Hedrick
------------------------------
W. Stephen Holmes III
------------------------------
Robert R. Momsen
Page 13 of 14 Pages
<PAGE>
EXHIBIT A
We, the undersigned, hereby express our agreement that the attached Schedule 13G
is filed on behalf of each of us.
Date: February ____, 1997
INTERWEST PARTNERS IV, L.P., a California ------------------------------
limited partnership Harvey B. Cash
By: InterWest Management Partners IV, L.P. ------------------------------
Alan W. Crites
By:
--------------------------------- ------------------------------
General Partner Philip T. Gianos
INTERWEST MANAGEMENT PARTNERS IV, L.P. ------------------------------
Wallace R. Hawley
By:
--------------------------------- ------------------------------
General Partner W. Scott Hedrick
------------------------------
W. Stephen Holmes III
------------------------------
Robert R. Momsen
Page 14 of 14 Pages