0001578260-15-000002.txt : 20150715 0001578260-15-000002.hdr.sgml : 20150715 20150715100126 ACCESSION NUMBER: 0001578260-15-000002 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20150715 DATE AS OF CHANGE: 20150715 EFFECTIVENESS DATE: 20150715 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Amphora Medical, Inc. CENTRAL INDEX KEY: 0001578260 IRS NUMBER: 454112773 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-197489 FILM NUMBER: 15988547 BUSINESS ADDRESS: STREET 1: 6901 EAST FISH LAKE ROAD STREET 2: SUITE 106 CITY: MAPLE GROVE STATE: MN ZIP: 55369 BUSINESS PHONE: 763-220-3730 MAIL ADDRESS: STREET 1: 6901 EAST FISH LAKE ROAD STREET 2: SUITE 106 CITY: MAPLE GROVE STATE: MN ZIP: 55369 D/A 1 primary_doc.xml X0707 D/A LIVE 0001578260 Amphora Medical, Inc. 6901 EAST FISH LAKE ROAD SUITE 106 MAPLE GROVE MN MINNESOTA 55369 763-220-3730 DELAWARE None None Corporation true 2011 Tom Ressemann 6901 East Fish Lake Road Suite 106 Maple Grove MN MINNESOTA 55369 Executive Officer Director Dan Sachs 6901 East Fish Lake Road Suite 106 Maple Grove MN MINNESOTA 55369 Director Michael Liang 227 West Monroe Street Suite 1900 Chicago IL ILLINOIS 60606 Director Robert Weisskoff 1 Main Street 13th Floor Cambridge MA MASSACHUSETTS 02142 Director Other Health Care Decline to Disclose 06b true 0001578260-13-000001 2013-05-24 false true false 0 12782106 12782106 0 false 8 0 0 768000 A portion of the proceeds will be used to pay the salaries of the executive officers in the ordinary course of business. false Amphora Medical, Inc. /s/ Tom Ressemann Tom Ressemann Chief Executive Officer 2015-07-13