0001637765-15-000001.txt : 20150330 0001637765-15-000001.hdr.sgml : 20150330 20150330163029 ACCESSION NUMBER: 0001637765-15-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20150330 DATE AS OF CHANGE: 20150330 EFFECTIVENESS DATE: 20150330 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Kips Bay Medical, Inc. CENTRAL INDEX KEY: 0001460198 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 208947689 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-236938 FILM NUMBER: 15734831 BUSINESS ADDRESS: STREET 1: 3405 ANNAPOLIS LANE CITY: MINNEAPOLIS STATE: MN ZIP: 55447 BUSINESS PHONE: 763-235-3540 MAIL ADDRESS: STREET 1: 3405 ANNAPOLIS LANE CITY: MINNEAPOLIS STATE: MN ZIP: 55447 D 1 primary_doc.xml X0707 D LIVE 0001460198 Kips Bay Medical, Inc. 3405 ANNAPOLIS LANE NORTH Suite 200 MINNEAPOLIS MN MINNESOTA 55447 763-235-3540 DELAWARE None None Corporation true Manny Villafana 3405 Annapolis Lane North Suite 200 Minneapolis MN MINNESOTA 55447 Executive Officer Director Scott Kellen 3405 Annapolis Lane North Suite 200 Minneapolis MN MINNESOTA 55447 Executive Officer Robert E. Munzenrider 3405 Annapolis Lane North Suite 200 Minneapolis MN MINNESOTA 55447 Director Arch C. Smith 3405 Annapolis Lane North Suite 200 Minneapolis MN MINNESOTA 55447 Director Robert J. Sheehy 3405 Annapolis Lane North Suite 200 Minneapolis MN MINNESOTA 55447 Director Randall K. LaBounty 3405 Annapolis Lane North Suite 200 Minneapolis MN MINNESOTA 55447 Executive Officer Other Health Care $1 - $1,000,000 06b false 2015-03-24 false true true false 250000 3250000 3250000 0 false 0 0 0 0 false Kips Bay Medical, Inc. /s/ Scott Kellen Scott Kellen Chief Operating Officer, CFO and Secretary 2015-03-30