Filing Details

Accession Number:
0000914190-12-000408
Form Type:
4
Zero Holdings:
No
Publication Time:
2012-06-21 15:46:54
Reporting Period:
2012-06-14
Filing Date:
2012-06-21
Accepted Time:
2012-06-21 15:46:54
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1460198 Kips Bay Medical Inc. KIPS Surgical & Medical Instruments & Apparatus (3841) 208947689
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1496876 Kips Bay Investments, Llc 8500 Normandale Boulevard
Suite 600
Bloomington MN 55437
No No Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2012-06-14 8,950 $1.00 11,850 No 4 P Indirect See Footnote
Common Stock Acquisiton 2012-06-15 690 $1.00 12,540 No 4 P Indirect See Footnote
Common Stock Acquisiton 2012-06-15 6,864 $1.00 19,404 No 4 P Indirect See Footnote
Common Stock Acquisiton 2012-06-18 22,500 $1.00 41,904 No 4 P Indirect See Footnote
Common Stock Acquisiton 2012-06-20 200 $0.99 42,104 No 4 P Indirect See Footnote
Common Stock Acquisiton 2012-06-20 4,900 $1.00 47,004 No 4 P Indirect See Footnote
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Indirect See Footnote
No 4 P Indirect See Footnote
No 4 P Indirect See Footnote
No 4 P Indirect See Footnote
No 4 P Indirect See Footnote
No 4 P Indirect See Footnote
Reported Non-Derivative Holdings
Sec. Name Remaning Holdings Nature of Ownership Explanation
Common Stock 6,789,056 Direct
Footnotes
  1. Shares held by principal equityholder of Kips Bay Investments, LLC. Kips Bay Investments, LLC disclaims beneficial ownership of such shares.