-----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, Gir2RNo+l0I9R+Tc5Bk3A25Ck94zCD0hOpe/S0aCPgid6xIixLl29YQdAmO2HzYr ju7K1Jfkptu/Z8UqNYeMxg== 0000950134-04-009789.txt : 20040708 0000950134-04-009789.hdr.sgml : 20040708 20040708101712 ACCESSION NUMBER: 0000950134-04-009789 CONFORMED SUBMISSION TYPE: 144 PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040708 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: CHAVEZ CHRISTOPHER G CENTRAL INDEX KEY: 0001192858 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 144 MAIL ADDRESS: STREET 1: 6501 WINDCREST DR STREET 2: SUITE 100 CITY: PLANO STATE: TX ZIP: 75024 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ADVANCED NEUROMODULATION SYSTEMS INC CENTRAL INDEX KEY: 0000351721 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 751646002 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 144 SEC ACT: 1933 Act SEC FILE NUMBER: 000-10521 FILM NUMBER: 04905313 BUSINESS ADDRESS: STREET 1: 6501 WINDCREST DRIVE SUITE 100 CITY: PLANO STATE: TX ZIP: 75024 BUSINESS PHONE: 9723098000 MAIL ADDRESS: STREET 1: 6501 WINDCREST DRIVE SUITE 100 CITY: PLANO STATE: TX ZIP: 75024 FORMER COMPANY: FORMER CONFORMED NAME: QUEST MEDICAL INC DATE OF NAME CHANGE: 19920703 144 1 d16676e144.txt FORM 144 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 144 NOTICE OF PROPOSED SALE OF SECURITIES PURSUANT TO RULE 144 UNDER THE SECURITIES ACT OF 1933 ATTENTION: Transmit for filing 3 copies of this form concurrently with either placing an order with a broker to execute sale or executing a sale directly with a market maker - -------------------------------------------------------------------------------- 1(a) NAME OF ISSUER (Please type or print) Advanced Neuromodulation Systems, Inc. - -------------------------------------------------------------------------------- 1(b) IRS IDENT. NO. |(c) SEC FILE NO. | 75-1646002 0-10521 | - -------------------------------------------------------------------------------- 1(d) ADDRESS OF ISSUER STREET 6501 Windcrest Drive, Suite 100 - -------------------------------------------------------------------------------- 1(d) CITY STATE ZIP CODE Plano Texas 75024 - -------------------------------------------------------------------------------- 1(e) TELEPHONE - -------------------------------------------------------------------------------- AREA CODE |NUMBER | 972 309-8000 | - -------------------------------------------------------------------------------- 2(a) NAME OF PERSON FOR WHOSE ACCOUNT THE SECURITIES ARE TO BE SOLD Christopher G. Chavez - -------------------------------------------------------------------------------- 2(b) IRS IDENT. NO. (c) RELATIONSHIP TO ISSUER President and CEO - -------------------------------------------------------------------------------- 2(d) ADDRESS STREET 2900 Cedar Ridge Road - -------------------------------------------------------------------------------- 2(d) CITY STATE ZIP CODE McKinney Texas 75070 - -------------------------------------------------------------------------------- INSTRUCTION: The person filing this notice should contact the issuer to obtain the I.R.S. Identification Number and the SEC File Number.
SEC USE 3(a) (b) ONLY (c) (d) (e) (f) (g) Title of the Name and Address of Broker- Number of Aggregate Number of Shares Approximate Name of Each Class of Each Broker Through Dealer Shares or Market or Other Units Date of Sale Securities Securities Whom the Securities File Other Units Value Outstanding (See instr. 3(f)) Exchange to be Sold are to be Offered Number to be Sold (See instr. (See instr. 3(e)) (MO. DAY YR.) (See instr. 3(g)) or Each Market (See instr. 3(d)) Maker who is 3(c)) Acquiring the Securities - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, Ryan Beck and Company $.05 Par Value 2125 Center Avenue Fort Lee, NJ 07024 3,000 94,050 20,173,697 July 7, 2004 NASDAQ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
INSTRUCTIONS: 1.(a) Name of issuer (b) Issuer's I.R.S. Identification Number (c) Issuer'S S.E.C. file number, if any (d) Issuer's address, including zip code (e) Issuer's telephone number, including area code 2.(a) Name of person for whose account the securities are to be sold (b) Such person's I.R.S. identification number, if such person is an entity (c) Such person's relationship to the issuer (e.g., officer, director, 10% stockholder, or member of immediate family of any of the foregoing) (d) Such person's address, including zip code 3.(a) Title of the class of securities to be sold (b) Name and address of each broker through whom the securities are intended to be sold (c) Number of shares or other units to be sold (if debt securities, give the aggregate face amount) (d) Aggregate market value of the securities to be sold as of a specified date within 10 days prior to the filing of this notice (e) Number of shares or other units of the class outstanding, or if debit securities the face amount thereof outstanding, as shown by the most recent report or statement published by the issuer (f) Approximate date on which the securities are to be sold (g) Name of each securities exchange, if any, on which the securities are intended to be sold TABLE I - SECURITIES TO BE SOLD Furnish the following information with respect to the acquisition of the securities to be sold and with respect to the payment of all or any part of the purchase price or other consideration therefor:
Name of Person from Whom Acquired Title of Date You Nature of (If gift, also give date Amount of Date of the Class Acquired Acquisition Transaction donor acquired) Securities Acquired Payment Nature of Payment - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 05/30/03 Stock Option Exercise ANSI 3,000 05/30/03 Cash - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
INSTRUCTIONS: 1. If the securities were purchased and full payment therefore was not made in cash at the time of purchase, explain in the table or in a note thereto the nature of the consideration given. If the consideration consisted of any note or other obligation, or if payment was made in installments describe the arrangement and state when the note or other obligation was discharged in full or the last installment paid. 2. If within two years after the acquisition of the securities the person for whose account they are to be sold had any short positions, put or other option to dispose of securities referred to in paragraph (d)(3) of Rule 144, furnish full information with respect thereto. TABLE II - SECURITIES SOLD DURING THE PAST 3 MONTHS Furnish the following information as to all securities of the issuer sold during the past 3 months by the person for whose account the securities are to be sold.
Amount of Gross Name and Address of Seller Title of Securities Sold Date of Sale Securities Proceeds - ------------------------------------------------------------------------------------------------------- Christopher G. Chavez 2900 Cedar Ridge Road McKinney, TX 75070 Common Stock $.05 Par Value 4/22/04 27,000 1,026,000 - -------------------------------------------------------------------------------------------------------
REMARKS: (1) On August 29, 2003, Christopher G. Chavez, President and Chief Executive Officer of Advanced Neuromodulation Systems, Inc. (ANSI), entered into a "Preset Diversification Program" (PDP), a stock disposition plan intended to qualify for the safe harbor offered by Rule 10b5-1 under the Securities Exchange Act of 1934, as amended, with an effective date of November 28, 2003. The shares covered by this Form 144 are being sold pursuant to this PDP. Mr. Chavez has informed the Company that the purpose of his PDP is to assist him in the diversification of his portfolio. Mr. Chavez represented to the Company that he had no knowledge of any material nonpublic information regarding the Company when he adopted his written PDP plan. INSTRUCTIONS: See the definition of "person" in paragraph (a) of Rule 144. Information is to be given not only as to the person for whose account the securities are to be sold but also as to sales by all persons whose sales are required by paragraph (e) of Rule 144 to be aggregated with sales for the account of the person filing this notice. ATTENTION: The person for whose account the securities to which this notice relates are to sold hereby represents by signing this notice that he does not know any material adverse information in regard to the current and prospective operations of the Issuer of the securities to be sold which have not been publicly disclosed. July 7, 2004 /s/ Linda Moses, by power of attorney - ----------------------------------- ---------------------------------------- (DATE OF NOTICE) (SIGNATURE) The notice shall be signed by the person for whose account the securities are to be sold. At least one copy of the notice shall be manually signed. Any copies not manually signed shall bear typed or printed signatures. ATTENTION: Intentional misstatements or omission of facts constitute Federal Criminal Violations (See 18 U.S.C. 1001). -----END PRIVACY-ENHANCED MESSAGE-----