| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 03/01/2005 |
3. Issuer Name and Ticker or Trading Symbol
REFOCUS GROUP INC [ RFCG.OB ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Series A-1 Convertible Preferred Stock | 03/01/2005 | (1) | Common Stock | 28,000,000 | 0.25 | D(2) | |
| Right to Acquire Series A-2 Convertible Preferred Stock(3) | 03/01/2005 | (4) | Series A-2 Convertible Preferred Stock | 280,000 | 25 | D(2) | |
| Warrant (Right to Buy)(5) | 03/01/2005 | 02/28/2007 | Series A-3 Convertible Preferred Stock | 133,334 | 30 | D(2) | |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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| Explanation of Responses: |
| 1. Shares of issuer's Series A-1 Convertible Preferred Stock are convertible into shares of issuer's Common Stock for as long as such shares are outstanding. |
| 2. The reported securities are owned directly by Medcare and indirectly by Medcare GP Corp, Inc., as general partner of Medcare, and Leininger, as a limited partner of Medcare. Medcare GP Corp, Inc. and Leininger disclaim beneficial ownership of the reported securities except to the extent of their respective pecuniary interest therein. |
| 3. Medcare has the right, pursuant to the terms of a Securities Purchase Agreement dated March 1, 2005 between issuer and Medcare, to purchase 280,000 shares of issuer's Series A-2 Convertible Preferred Stock, which are currently convertible into 28,000,000 shares of issuer's Common Stock at a conversion price of $0.25 per share. |
| 4. Medcare's right to acquire 280,000 shares of issuer's Series A-2 Convertible Preferred Stock does not expire. |
| 5. The 133,334 shares of issuer's Series A-3 Convertible Preferred Stock issuable upon the exercise of this warrant are currently convertible into 13,333,400 shares of issuer's Common Stock at an exercise price of $0.30 per share. |
| Remarks: |
| This report is filed jointly by Medcare Investment Fund III, Ltd. ("Medcare") and Medcare GP Corp, Inc., its corporate general partner, and James R. Leininger, M.D., a limited partner, as 10% owners of issuer. Medcare also may be deemed a director by virtue of its right to elect one-half of the members of issuer's board of directors. Thomas W. Lyles, Jr. and Douglas Williamson currently serve as Medcare's representatives on issuer's board of directors. |
| /s/ Thomas W. Lyles, Jr., President of Medcare GP Corp, Inc., as general partner of Medcare Investment Fund III, Ltd. and as Attorney-in-Fact | 03/10/2005 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
| ** Intentional misstatements or omissions of facts constitute Federal 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 is insufficient, see Instruction 6 for procedure. | ||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. | ||