0001104659-11-055786.txt : 20111012 0001104659-11-055786.hdr.sgml : 20111012 20111012124639 ACCESSION NUMBER: 0001104659-11-055786 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: Rule 506 FILED AS OF DATE: 20111012 DATE AS OF CHANGE: 20111012 EFFECTIVENESS DATE: 20111012 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Avantis Medical Systems Inc CENTRAL INDEX KEY: 0001325768 IRS NUMBER: 000000000 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-167088 FILM NUMBER: 111137103 BUSINESS ADDRESS: STREET 1: 263 SANTA ANA COURT CITY: SUNNYVALE STATE: CA ZIP: 94085 BUSINESS PHONE: 408-733-1901 MAIL ADDRESS: STREET 1: 263 SANTA ANA COURT CITY: SUNNYVALE STATE: CA ZIP: 94085 D 1 primary_doc.xml X0704 D LIVE 0001325768 Avantis Medical Systems Inc 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 408-733-1847 CALIFORNIA None None Corporation true Richard Randall 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Executive Officer Director John Reed 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Executive Officer Daniel George 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Executive Officer Thomas J. Fogarty 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Director Matthew Jenusaitis 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Executive Officer Director Camran Nezhat 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Director Howard Palefsky 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Director John Savarese 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Director John H. Higgins 263 Santa Ana Court Sunnyvale CA CALIFORNIA 94085 Executive Officer Other Health Care Decline to Disclose 06 false 2011-09-30 false true true false 0 150000 150000 0 false 1 0 0 0 Funds to be used for working capital. false Avantis Medical Systems Inc /s/ Daniel George Daniel George Chief Financial Officer 2011-10-12