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SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Schedule 13G
Under the Securities Exchange Act of 1934
(Amendment No. )*
Urologix, Inc.
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(Name of Issuer)
Common Stock, Par Value $0.01
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(Title of Class of Securities)
917273 10 4
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(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).
(Continued on following page(s))
Page 1 of 6 Pages
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CUSIP No. 917273 10 4 13G Page 2 of 6 Pages
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1 NAME OF REPORTING PERSON
S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
Mitchell Dann
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2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) [_]
(b) [_]
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
American
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5 SOLE VOTING POWER
NUMBER OF
570,957
SHARES
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BENEFICIALLY 6 SHARED VOTING POWER
OWNED BY 0
EACH ------------------------------------------------
7 SOLE DISPOSITIVE POWER
REPORTING
570,957
PERSON
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WITH 8 SHARED DISPOSITIVE POWER
0
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
570,957
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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
6.1%
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12 TYPE OF REPORTING PERSON*
IN
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*SEE INSTRUCTION BEFORE FILLING OUT!
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Item 1.
(a) Name of Issuer
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Urologix, Inc., a Minnesota corporation
(b) Address of Issuer's Principal Executive Offices
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Urologix, Inc., 14405 21st Avenue North, Minneapolis, MN 55447
Item 2.
(a) Name of Person Filing. This statement is being filed by
---------------------
Mitchell Dann, an individual.
(b) Address of Principal Business Office or, if none, Residence. The
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principal address of Mr. Dann is c/o M. Dann & Company, 185 B
Center Street, P.O. Box 9215, Jackson, WY 83002.
(c) Citizenship. Mr. Dann is an American citizen.
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(d) Title of Class of Securities. Common Stock, $0.01 par
----------------------------
value per share.
(e) CUSIP Number. 917273 10 4
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Item 3. If this statement is filed pursuant to Rule 13d-1(b), or
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13d-2(b), check whether the person filing is a:
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(a) [_] Broker or Dealer registered under Section 15 of the Act
(b) [_] Bank as defined in Section 3(a)(6) of the Act
(c) [_] Insurance Company as defined in Section
3(a)(19) of the Act
(d) [_] Investment Company registered under Section 8 of the
Investment Company Act
(e) [_] Investment Adviser registered under Section 203 of the
Investment Advisers Act of 1940
(f) [_] Employee Benefit Plan, Pension Fund which is subject to the
provisions of the Employee Retirement Income Security Act of
1974 or Endowment Fund; see (S).240.13d-1(b)(1)(ii)(F)
(g) [_] Parent Holding Company, in accordance with
(S).240.13d-1(b)(ii)(G) (Note: See Item 7)
Page 3 of 6 Pages
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(h) [_] Group, in accordance with (S).240.13d-1(b)(ii)(H)
Not Applicable.
Item 4. Ownership
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As of December 31, 1996, the ownership of Mr. Dann was as follows:
(a) Amount Beneficially Owned - 570,957
(b) Percent of Class - 6.1%
(c) Of the shares owned by Mr. Dann, Mr. Dann has the power to
vote or dispose of the shares as follows:
(i) Sole power to vote or direct the vote - 570,957
(ii) Shared power to vote or direct the
vote - 0
(iii) Sole power to dispose or direct the
disposition of - 570,957
(iv) Shared power to dispose or direct the
disposition of - 0
Of the shares beneficially owned by Mr. Dann, 17,500 shares are deemed
owned present to currently exercisable options. In addition, 5,538 shares
are owned by M. Dann Profit Sharing Trust for the benefit of Mr. Dann.
Item 5. Ownership of Five Percent or less of a Class
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Not Applicable.
Item 6. Ownership of More Than Five Percent on Behalf of Another Person
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Not Applicable.
Page 4 of 6 Pages
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Item 7. Identification and Classification of the Subsidiary which
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Acquired the Security Reported on by the Parent Holding Company.
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If a parent holding company has filed this schedule, pursuant to
Rule 13d-1(b)(iii)(G), so indicate under Item 3(g) and attach an exhibit stating
the identity and the Item 3 classification of the relevant subsidiary. If a
parent holding company has filed this schedule pursuant to Rule 13d-1(c), attach
an exhibit stating the identification of the relevant subsidiary.
Not Applicable.
Item 8. Identification and Classification of Members of the Group
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Not Applicable.
Item 9. Notice of Dissolution of Group
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Not Applicable.
Item 10. Certificates
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The following certificates shall be included if the statement is
filed pursuant to Rule 13d-1(b):
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 purposes or effect.
Not Applicable.
Page 5 of 6 Pages
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SIGNATURES
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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.
February 12, 1997 /s/ Mitchell Dann
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Mitchell Dann
Page 6 of 6 Pages
