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- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION
FORM 3 WASHINGTON, D.C. 20549
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INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person 2. Date of Event Re- 4. Issuer Name and Ticker or Trading Symbol
quiring Statement
(Month/Day/Year)
Pappajohn John Image Guided Technologies, Inc./IGTI
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(Last) (First) (Middle) 5. Relationship of Reporting Person(s) 6. If Amendment, Date
----------------------- to Issuer (Check all applicable) of Original
3. IRS or Social Se- Director X 10% Owner (Month/Day/Year)
curity Number of ---- ----
2116 Financial Center Reporting Person Officer (give Other (specify ---------------------
- ------------------------------------------------- (Voluntary) title below) below) 7. Individual or
(Street) ---- ---- Joint/Group Filing
(Check Applicable
Line)
--------------------------- Form filed by One
X Reporting Person
---
Form filed by
More than One
Reporting Person
Des Moines IA 50309 ---
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(City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial
(Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5)
(Instr. 4) (D) or Indirect
(I) (Instr. 5)
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Common Stock, no par value 162,601 D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
(Print or Type Responses) SEC 1473 (7-96)
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FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE
SECURITIES)
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1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial
Expiration (Instr. 4) Exercise Form of Ownership
Date Price of Deriv- (Instr. 5)
(Month/Day/ Deri- ative
Year) vative Security:
-------------------------------------------------- Security Direct
Amount (D) or
Date Expir- of Indirect
Exer- ation Title Number (I)
cisable Date of
Shares (Instr. 5)
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Series A Preferred Stock (1) (1) Common Stock, 70,219 N/A (1) D
no par value
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Explanation of Responses:
(1) Will be converted, without payment of any conversion price, into 70,219 shares of the Company's no par value Common Stock on
the Closing Date of the Initial Public Offering.
/s/ JOHN PAPPAJOHN
------------------------------------- October 11, 1996
**Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person
Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space provided is
insufficient, see Instruction 6 for procedure.
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SEC 1473 (7-96)
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