0001578260-17-000001.txt : 20170727 0001578260-17-000001.hdr.sgml : 20170727 20170727160308 ACCESSION NUMBER: 0001578260-17-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20170727 DATE AS OF CHANGE: 20170727 EFFECTIVENESS DATE: 20170727 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 SEC ACT: 1933 Act SEC FILE NUMBER: 021-291644 FILM NUMBER: 17986247 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 1 primary_doc.xml X0708 D 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 Thomas V. Ressemann 6901 East Fish Lake Road Suite 106 Maple Grove MN MINNESOTA 55369 Executive Officer Director Ketan Patel One Main Street 13th Floor Cambridge MA MASSACHUSETTS 02142 Director Nicole J. Walker 227 West Monroe Street Suite 1900 Chicago IL ILLINOIS 60606 Director Thomas Thaler Bundesplatz P.O. Box 1145 Zug V8 SWITZERLAND 6300 Director Marc Galletti 800 El Camino Real Suite 220 Menlo Park CA CALIFORNIA 94025 Director Chris Owens 501 North Sarah Deel Drive Apt. 1223 Webster TX TEXAS 77598 Director Other Health Care Decline to Disclose 06b false 2017-07-17 false true false 5099 Aquilo Partners, L.P. 114909 None None One Maritime Plaza 14th Floor San Francisco CA CALIFORNIA 94111 CA CALIFORNIA MA MASSACHUSETTS false 35512180 11012180 24500000 false 12 700000 0 0 Other than the payment of salaries and other compensation and benefits, no officer, director, manager or promoter will receive any payments from the proceeds of this offering. false Amphora Medical, Inc. /s/Thomas V. Ressemann Thomas V. Ressemann Chief Executive Officer 2017-07-26