-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, DHvdoMmz6JdD9PDDDvCSqcKp4a9YEJIFySOG5fAPXJNba1GJqBoOsUa0ehXn82Tz N4QqmBJlbmbtde1zy6T/uA== 0000914190-09-000716.txt : 20091103 0000914190-09-000716.hdr.sgml : 20091103 20091103152033 ACCESSION NUMBER: 0000914190-09-000716 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091102 FILED AS OF DATE: 20091103 DATE AS OF CHANGE: 20091103 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AGA Medical Holdings, Inc. CENTRAL INDEX KEY: 0001421419 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 204757212 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 5050 NATHAN LANE N CITY: PLYMOUTH STATE: MN ZIP: 55442 BUSINESS PHONE: 763-513-9227 MAIL ADDRESS: STREET 1: 5050 NATHAN LANE N CITY: PLYMOUTH STATE: MN ZIP: 55442 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HELMS JACK P CENTRAL INDEX KEY: 0001018553 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] STATE OF INCORPORATION: DE FISCAL YEAR END: 1225 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34494 FILM NUMBER: 091154273 MAIL ADDRESS: STREET 1: C/O APPLEBEE'S INTERNATIONAL, INC. STREET 2: 4551 W 107TH STREET CITY: OVERLAND PARK STATE: KS ZIP: 66207 4 1 edgar.xml PRIMARY DOCUMENT X0303 4 2009-11-02 0001421419 AGA Medical Holdings, Inc. AGAM 0001018553 HELMS JACK P 4906 LAKEVIEW DRIVE EDINA MN 55424 1 0 0 0 Stock Option (Right to Buy) 13.64 2009-11-02 4 A 0 6293 0 A 2016-11-02 Common Stock 6293 6293 D 2,097 shares vest on 11/2/10 and 2,098 shares vest on each of 11/2/11 and 11/2/12. /s/ Brigid A. Makes as attorney-in-fact for Jack P. Helms pursuant to Power of Attorney previously filed 2009-11-03 -----END PRIVACY-ENHANCED MESSAGE-----