0001347123-17-000003.txt : 20171116 0001347123-17-000003.hdr.sgml : 20171116 20171116171704 ACCESSION NUMBER: 0001347123-17-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20171116 DATE AS OF CHANGE: 20171116 EFFECTIVENESS DATE: 20171116 FILER: COMPANY DATA: COMPANY CONFORMED NAME: EBR Systems, Inc. CENTRAL INDEX KEY: 0001347123 IRS NUMBER: 571164669 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-298964 FILM NUMBER: 171208793 BUSINESS ADDRESS: STREET 1: 480 OAKMEAD PARKWAY CITY: SUNNYVALE STATE: CA ZIP: 94085 BUSINESS PHONE: 408 720-1906 MAIL ADDRESS: STREET 1: 480 OAKMEAD PARKWAY CITY: SUNNYVALE STATE: CA ZIP: 94085 FORMER COMPANY: FORMER CONFORMED NAME: EBR Systems Inc DATE OF NAME CHANGE: 20051216 D 1 primary_doc.xml X0708 D LIVE 0001347123 EBR Systems, Inc. 480 OAKMEAD PARKWAY SUNNYVALE CA CALIFORNIA 94085 408 720-1906 DELAWARE EBR Systems Inc Corporation true Allan R. Will 480 Oakmead Parkway Sunnyvale CA CALIFORNIA 94085 Executive Officer Director Trevor Moody 480 Oakmead Parkway Sunnyvale CA CALIFORNIA 94085 Director Leighton Read 480 Oakmead Parkway Sunnyvale CA CALIFORNIA 94085 Director Chris Nave 480 Oakmead Parkway Sunnyvale CA CALIFORNIA 94085 Director Dave Stassen 480 Oakmead Parkway Sunnyvale CA CALIFORNIA 94085 Director Richard Riley 480 Oakmead Parkway Sunnyvale CA CALIFORNIA 94085 Executive Officer Other Health Care Decline to Disclose 06b false 2017-10-30 false true true true Sale and issuance of New Series B Preferred Stock and the underlying Common Stock issuable upon conversion thereof. false 0 55987132 41048365 14938767 false 29 0 0 0 true Proceeds will be used for general corporate purposes. false EBR Systems, Inc. /s/ Allan R. Will Allan R. Will Chief Executive Officer 2017-11-16