0001347123-14-000002.txt : 20140715 0001347123-14-000002.hdr.sgml : 20140715 20140715103219 ACCESSION NUMBER: 0001347123-14-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20140715 DATE AS OF CHANGE: 20140715 EFFECTIVENESS DATE: 20140715 FILER: COMPANY DATA: COMPANY CONFORMED NAME: EBR Systems, Inc. CENTRAL INDEX KEY: 0001347123 IRS NUMBER: 571164669 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-221042 FILM NUMBER: 14974934 BUSINESS ADDRESS: STREET 1: 686 WEST MAUDE AVE, STE 102 CITY: SUNNYVALE STATE: CA ZIP: 94085 BUSINESS PHONE: 408 720-1906 MAIL ADDRESS: STREET 1: 686 WEST MAUDE AVE, STE 102 CITY: SUNNYVALE STATE: CA ZIP: 94085 FORMER COMPANY: FORMER CONFORMED NAME: EBR Systems Inc DATE OF NAME CHANGE: 20051216 D 1 primary_doc.xml X0707 D LIVE 0001347123 EBR Systems, Inc. 686 WEST MAUDE AVE, STE 102 SUNNYVALE CA CALIFORNIA 94085 408 720-1906 DELAWARE EBR Systems Inc Corporation true Allan R. Will 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Executive Officer Director Richard E. Riley 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Executive Officer Director Parker Willis 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Executive Officer Mark Cowan 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Executive Officer Stephen O'Conner 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Executive Officer John Maroney c/o EBR Systems, Inc. 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Director Stephen H. Mahle c/o EBR Systems, Inc. 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Director William Starling c/o EBR Systems, Inc. 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Director Joshua J. Baltzell c/o EBR Systems, Inc. 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Director David Milne c/o EBR Systems, Inc. 686 W. Maude Avenue, Suite 102 Sunnyvale CA CALIFORNIA 94085 Director Thomas Fogarty c/o EBR Systems, Inc. 686 W. Maude Avenue, Suite 102 Sunnyale CA CALIFORNIA 94085 Director Other Health Care Decline to Disclose 06b false 2014-07-01 false true false 0 35629819 18729813 16900006 $8,503,866.09 of the total amount sold is comprised of the conversion of principal and interest relating to convertible promissory notes. false 18 0 0 0 false EBR Systems, Inc. /s/ Allan R. Will Allan R. Will Chief Executive Officer 2014-07-15