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OMB APPROVAL
OMB Number 3235-0145
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(AMENDMENT NO. ___________)*
UroQuest Medical Corporation
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(Name of Issuer)
Common Stock, par value $0.001
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(Title of Class of Securities)
917285 10 8
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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 filing 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 five percent or less of such class.)
(See rule 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 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 4 Pages
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CUSIP NO. 917285 10 8 SCHEDULE 13G PAGE 2 OF 4 PAGES
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(1) NAMES OF REPORTING PERSONS
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS
RICHARD C. DAVIS, M.D.
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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
United States
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(5) SOLE VOTING POWER
NUMBER OF 1,081,786
SHARES --------------------------------------------------------
BENEFICIALLY (6) SHARED VOTING POWER
OWNED BY
EACH --------------------------------------------------------
REPORTING (7) SOLE DISPOSITIVE POWER
PERSON WITH 1,081,786
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(8) SHARED DISPOSITIVE POWER
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(9) AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
1,081,786
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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
9.08%
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(12) TYPE OF REPORTING PERSON*
IN
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*SEE INSTRUCTIONS BEFORE FILLING OUT!
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ITEM 1.
(a) Name of Issuer: UroQuest Medical Corporation (the "Issuer")
(b) Address of Principal Executive Offices:
265 East 100 South, Suite 220
Salt Lake City, Utah 84111
ITEM 2.
(a) Name of Person Filing: Richard C. Davis, M.D.
(b) Address of Principal Business Office:
4820 Longwater Way
Tampa, Florida 33615
(c) Citizenship: United States
(d) Title of Class of Securities: Common Stock, $0.001 par value
of the Issuer
(e) CUSIP Number: 917285 10 8
ITEM 3.
This statement is not filed pursuant to Rule 13d-1(b) or 13d-2(b).
ITEM 4. OWNERSHIP
As of December 31, 1996, Richard C. Davis, M.D. was the beneficial
owner of 1,081,786 shares of the Issuer's Common Stock (the "Shares"). Dr.
Davis held 1,012,619 of the Shares as trustee of the Richard C. Davis, Jr.
Revocable Trust, dated February 23, 1993, as to which Dr. Davis has sole
investment and voting power as trustee. Dr. Davis held 69,167 of the Shares by
virtue of his right to exercise stock options pursuant to Rule 13d-3 as to
which Dr. Davis has sole investment and voting power.
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
Not applicable.
Page 3 of 4 Pages
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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.
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.
DATED: February 11, 1997
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By: /s/ Richard Davis
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Richard C. Davis, M.D.
