SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Schedule 13G
(Rule 13d-102)
INFORMATION STATEMENT PURSUANT TO RULES 13d-1 AND 13d-2
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(Amendment No._______)*
Fusion Medical Technologies, Inc.
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(Name of Issuer)
Common Stock
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(Title of Class of Securities)
0003611281
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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
disclosures provided in a prior cover page.
The information required on 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 pages)
Page 1 of 13 Pages
Exhibit Index Contained on Page 12
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CUSIP NO. 0003611281 13 G Page 2 of 13 Pages
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1 NAME OF REPORTING PERSONS
SS OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS
Mohr, Davidow Ventures III, A California Limited
Partnership ("MDV III")
Tax ID Number: 94-3150283
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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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5 SOLE VOTING POWER
NUMBER OF 992,510 shares except that WLPJ
BENEFICIALLY Partners, the general partner of
OWNED BY EACH REPORTING MDV SHARES III, and Mohr, Davidow,
PERSON Feiber and Schoendorf, the general
WITH partners of WLPJ Partners, may be
deemed to have shared power to vote
these shares.
--------------------------------------------
6 SHARED VOTING POWER
See response to row 5.
--------------------------------------------
7 SOLE DISPOSITIVE POWER
992,510 shares, except that WLPJ
Partners, the general partner of
MDV III, and Mohr, Davidow, Feiber
and Schoendorf, the general
partners of WLPJ Partners, may be
deemed to have shared power to
dispose of these shares.
--------------------------------------------
8 SHARED DISPOSITIVE POWER
See response to row 7.
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON 992,510
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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
14.3%
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12 TYPE OF REPORTING PERSON*
PN
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* SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
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CUSIP NO. 0003611281 13 G Page 3 of 13 Pages
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1 NAME OF REPORTING PERSONS
SS OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS
WLPJ Partners, A California Limited Partnership ("WLPJ")
Tax ID Number: 94-3150282
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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
BENEFICIALLY 0 shares.
OWNED BY EACH REPORTING --------------------------------------------
PERSON 6 SHARED VOTING POWER
WITH 992,510 shares of which all are
directly owned by MDV III. WLPJ is
the general partner of MDV III and
may be deemed to have shared power
to vote these shares.
--------------------------------------------
7 SOLE DISPOSITIVE POWER
0 shares.
--------------------------------------------
8 SHARED DISPOSITIVE POWER
992,510 shares of which all are
directly owned by MDV III. WLPJ is
the general partner of MDV III and
may be deemed to have shared power
to dispose of these shares.
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON 992,510
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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
14.3%
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12 TYPE OF REPORTING PERSON*
PN
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* SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
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CUSIP NO. 0003611281 13 G Page 4 of 13 Pages
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1 NAME OF REPORTING PERSONS
SS OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS
Lawrence G. Mohr, Jr. ("Mohr")
Tax ID Number: ###-##-####
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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
BENEFICIALLY 18,285 shares, of which 10,000
OWNED BY EACH REPORTING shares are owned directly and 8,285
PERSON shares are issuable upon the
WITH exercise of stock options.
--------------------------------------------
6 SHARED VOTING POWER
1,005,010 shares, of which 992,510
are directly owned by MDV III and
12,500 of which are held by
Lawrence G. Mohr, Jr. and Nancy H.
Mohr, Trustees of the Mohr Family
Trust U/D/T Dated August 5, 1985.
Mohr is a general partner of WLPJ,
the general partner of MDV III, and
may be deemed to have shared power
to vote these shares.
--------------------------------------------
7 SOLE DISPOSITIVE POWER
18,285 shares, of which 10,000
shares are owned directly, and
8,285 shares are issuable upon the
exercise of stock options.
--------------------------------------------
8 SHARED DISPOSITIVE POWER
1,005,010 shares, of which 992,510
are directly owned by MDV III and
12,500 of which are held by
Lawrence G. Mohr, Jr. and Nancy H.
Mohr, Trustees of the Mohr Family
Trust U/D/T Dated August 5, 1985.
Mohr is a general partner of WLPJ,
the general partner of MDV III, and
may be deemed to have shared power
to dispose of these shares.
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON 1,023,295
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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
14.75%
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12 TYPE OF REPORTING PERSON*
IN
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* SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
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CUSIP NO. 0003611281 13 G Page 5 of 13 Pages
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1 NAME OF REPORTING PERSONS
SS OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS
William H. Davidow ("Davidow")
Tax ID Number: ###-##-####
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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
BENEFICIALLY 0 shares.
OWNED BY EACH REPORTING --------------------------------------------
PERSON 6 SHARED VOTING POWER
WITH 992,510 shares of which all are
directly owned by MDV III. Davidow
is a general partner of WLPJ, the
general partner of MDV III, and may
be deemed to have shared power to
vote these shares.
--------------------------------------------
7 SOLE DISPOSITIVE POWER
0 shares.
--------------------------------------------
8 SHARED DISPOSITIVE POWER
992,510 shares of which all are
directly owned by MDV III. Davidow
is a general partner of WLPJ, the
general partner of MDV III, and may
be deemed to have shared power to
dispose of these shares.
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON 992,510
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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
14.3%
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12 TYPE OF REPORTING PERSON*
IN
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* SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
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CUSIP NO. 0003611281 13 G Page 6 of 13 Pages
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1 NAME OF REPORTING PERSONS
SS OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS
Jonathan D. Feiber ("Feiber")
Tax ID Number: ###-##-####
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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
SHARES 0 shares.
BENEFICIALLY --------------------------------------------
OWNED BY EACH REPORTING 6 SHARED VOTING POWER
PERSON 992,510 shares of which all are
WITH directly owned by MDV III. Feiber
is a general partner of WLPJ, the
general partner of MDV III, and may
be deemed to have shared power to
vote these shares.
--------------------------------------------
7 SOLE DISPOSITIVE POWER
0 shares.
--------------------------------------------
8 SHARED DISPOSITIVE POWER
992,510 shares of which all are
directly owned by MDV III. Feiber
is a general partner of WLPJ, the
general partner of MDV III, and may
be deemed to have shared power to
dispose of these shares.
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON 992,510
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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
14.3%
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12 TYPE OF REPORTING PERSON*
IN
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* SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
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CUSIP NO. 0003611281 13 G Page 7 of 13 Pages
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1 NAME OF REPORTING PERSONS
SS OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS
Nancy J. Schoendorf ("Schoendorf")
Tax ID Number: ###-##-####
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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
SHARES 0 shares.
BENEFICIALLY --------------------------------------------
OWNED BY EACH REPORTING 6 SHARED VOTING POWER
PERSON 992,510 shares of which all are
WITH directly owned by MDV III.
Schoendorf is a general partner of
WLPJ, the general partner of MDV
III, and may be deemed to have
shared power to vote these shares.
--------------------------------------------
7 SOLE DISPOSITIVE POWER
0 shares.
--------------------------------------------
8 SHARED DISPOSITIVE POWER
992,510 shares of which all are
directly owned by MDV III.
Schoendorf is a general partner of
WLPJ, the general partner of MDV
III, and may be deemed to have
shared power to dispose of these
shares.
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON 992,510
- --------------------------------------------------------------------------------
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
14.3%
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12 TYPE OF REPORTING PERSON*
IN
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* SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
Page 8 of 13 Pages
ITEM 1(a). NAME OF ISSUER:
Fusion Medical Technologies, Inc.
ITEM 1(b). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES:
1804 North Shoreline Boulevard
Mountain View, CA 94043
ITEM 2(a). NAME OF PERSONS FILING:
This Statement is filed by Mohr Davidow Ventures III, A
California Limited Partnership ("MDV III"), WLPJ Partners, A California Limited
Partnership ("WLPJ"), Lawrence G. Mohr, Jr. ("Mohr"), William H. Davidow
("Davidow"), Jonathan D. Feiber ("Feiber") and Nancy J. Schoendorf
("Schoendorf"). The foregoing entities and individuals are collectively referred
to as the "Reporting Persons."
WLPJ is the general partner of MDV III, and may be deemed to
have shared power to vote and shared power to dispose of shares of the issuer
directly owned by MDV III. Mohr, Davidow, Feiber and Schoendorf are the general
partners of WLPJ, and may be deemed to have shared power to vote and shared
power to dispose of the shares of issuer directly owned by MDV III.
ITEM 2(b). ADDRESS OF PRINCIPAL BUSINESS OFFICE, OR, IF NONE RESIDENCE:
The address of the principal business office for each of the
Reporting Persons is:
Mohr Davidow Ventures
3000 Sand Hill Road
Building 1, Suite 240
Menlo Park, CA 94025
ITEM 2(c) CITIZENSHIP:
MDV III and WLPJ are California limited partnerships and Mohr,
Davidow, Feiber and Schoendorf are United States citizens.
ITEM 2(d). TITLE OF CLASS OF SECURITIES:
Common Stock
<PAGE>
Page 9 of 13 Pages
ITEM 2(e). CUSIP NUMBER:
CUSIP # 0003611281
ITEM 3. Not Applicable
ITEM 4. OWNERSHIP:
The following information with respect to the ownership of the
Common Stock of the issuer by the persons filing this
Statement is provided as of December 31, 1996:
(a) Amount beneficially owned:
See Row 9 of cover page for each Reporting Person.
(b) Percent of Class:
See Row 11 of cover page for each Reporting Person.
(c) Number of shares as to which such person has:
(i) Sole power to vote or to direct the vote:
See Row 5 of cover page for each Reporting
Person.
(ii) Shared power to vote or to direct the vote:
See Row 6 of cover page for each Reporting
Person.
(iii) Sole power to dispose or to direct the
disposition of:
See Row 7 of cover page for each Reporting
Person.
(iv) Shared power to dispose or to direct the
disposition of:
See Row 8 of cover page for each Reporting
Person.
<PAGE>
Page 10 of 13 Pages
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 limited
partnership agreements of MDV III and WLPJ, the general and
limited partners of each of such entities may be deemed to have
the right to receive dividends from, or the proceeds from, the
sale of shares of the issuer owned by each such entity of which
they are a partner.
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:
Not applicable
ITEM 9. NOTICE OF DISSOLUTION OF GROUP:
Not applicable
ITEM 10. CERTIFICATION:
Not applicable
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Page 11 of 13 Pages
SIGNATURES
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 12, 1997
/s/ Lawrence G. Mohr, Jr.
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Lawrence G. Mohr, Jr., individually and on
behalf of MDV III in his capacity as a
general partner of WLPJ, the general partner of
MDV III, and on behalf of WLPJ in his capacity as
a general partner thereof.
/s/ William H. Davidow
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William H. Davidow
/s/ Jonathan D. Feiber
-------------------------------------------------
Jonathan D. Feiber
/s/ Nancy J. Schoendorf
-------------------------------------------------
Nancy J. Schoendorf
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Page 12 of 13 Pages
EXHIBIT INDEX
Found on
Sequentially
Exhibit Numbered Page
Exhibit A: Agreement of Joint Filing 13
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Page 13 of 13 Pages
EXHIBIT A
Agreement of Joint Filing
The undersigned hereby agree that a single Schedule 13G (or
any amendment thereto) relating to the Common Stock of Fusion Medical
Technologies, Inc. shall be filed on behalf of each of the undersigned and that
this Agreement shall be filed as an exhibit to such Schedule 13G.
Date: February 12, 1997
/s/ Lawrence G. Mohr, Jr.
-------------------------------------------------
Lawrence G. Mohr, Jr., individually and on
behalf of MDV III in his capacity as a
general partner of WLPJ, the general partner of
MDV III, and on behalf of WLPJ in his capacity as
a general partner thereof.
/s/ William H. Davidow
-------------------------------------------------
William H. Davidow
/s/ Jonathan D. Feiber
-------------------------------------------------
Jonathan D. Feiber
/s/ Nancy J. Schoendorf
-------------------------------------------------
Nancy J. Schoendorf
