Form D Raw Data - Electronic Filing Depository

EFDID: 131168EFD: Raw Data

Issuer: SURGIVISION INC (0001285550) - D

Accession: 0001285550-09-000005 () (EDGAR Files) (Form D)

Edgar Posted: Nov. 6, 2009
EFD Posted: Jan. 6, 2015

- < edgarSubmission >

< schemaVersion > X0603 </ schemaVersion >

< submissionType > D </ submissionType >

< testOrLive > LIVE </ testOrLive >

- < primaryIssuer >

< cik > 0001285550 </ cik >

< entityName > SURGIVISION INC </ entityName >

- < issuerAddress >

< street1 > ONE COMMERCE SQUARE </ street1 >

< street2 > SUITE 2550 </ street2 >

< city > MEMPHIS </ city >

< stateOrCountry > TN </ stateOrCountry >

< zipCode > 38103 </ zipCode >

</ issuerAddress >

< issuerPhoneNumber > 9015229300 </ issuerPhoneNumber >

< jurisdictionOfInc > DELAWARE </ jurisdictionOfInc >

- < edgarPreviousNameList >

< previousName > SURGI VISION INC </ previousName >

</ edgarPreviousNameList >

< entityType > Corporation </ entityType >

- < yearOfInc >

< overFiveYears > true </ overFiveYears >

</ yearOfInc >

</ primaryIssuer >

- < relatedPersonsList >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Kimble </ firstName >

< middleName > L. </ middleName >

< lastName > Jenkins </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > One Commerce Square </ street1 >

< street2 > Suite 2550 </ street2 >

< city > Memphis </ city >

< stateOrCountry > TN </ stateOrCountry >

< zipCode > 38103 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > President, Chief Executive Officer and Chairman of the Board of Directors </ relationshipClarification >

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > John </ firstName >

< lastName > Thomas </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 200 North Cobb Parkway </ street1 >

< street2 > Suite 140 </ street2 >

< city > Marietta </ city >

< stateOrCountry > GA </ stateOrCountry >

< zipCode > 30062 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > Chief Financial Officer and Director </ relationshipClarification >

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Lenox </ firstName >

< lastName > Baker </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > One Commerce Square </ street1 >

< street2 > Suite 2550 </ street2 >

< city > Memphis </ city >

< stateOrCountry > TN </ stateOrCountry >

< zipCode > 38103 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > Director </ relationshipClarification >

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Paul </ firstName >

< lastName > Bottomely </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > One Commerce Square </ street1 >

< street2 > Suite 2550 </ street2 >

< city > Memphis </ city >

< stateOrCountry > TN </ stateOrCountry >

< zipCode > 38103 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > Director </ relationshipClarification >

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Charles </ firstName >

< lastName > Koob </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > One Commerce Square </ street1 >

< street2 > Suite 2550 </ street2 >

< city > Memphis </ city >

< stateOrCountry > TN </ stateOrCountry >

< zipCode > 38103 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > Director </ relationshipClarification >

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Wendelin </ firstName >

< lastName > Maners </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > One Commerce Square </ street1 >

< street2 > Suite 2550 </ street2 >

< city > Memphis </ city >

< stateOrCountry > TN </ stateOrCountry >

< zipCode > 38103 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > Director </ relationshipClarification >

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Parker </ firstName >

< middleName > H. </ middleName >

< lastName > Petit </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > One Commerce Square </ street1 >

< street2 > Suite 2550 </ street2 >

< city > Memphis </ city >

< stateOrCountry > TN </ stateOrCountry >

< zipCode > 38103 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > Director </ relationshipClarification >

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Peter </ firstName >

< lastName > Piferi </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 5 Musik </ street1 >

< city > Irvine </ city >

< stateOrCountry > CA </ stateOrCountry >

< zipCode > 92618 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > Chief Operating Officer </ relationshipClarification >

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Oscar </ firstName >

< middleName > L. </ middleName >

< lastName > Thomas, Jr. </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > One Commerce Square </ street1 >

< street2 > Suite 2550 </ street2 >

< city > Memphis </ city >

< stateOrCountry > TN </ stateOrCountry >

< zipCode > 38103 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification > Vice President, Business Affairs </ relationshipClarification >

</ relatedPersonInfo >

</ relatedPersonsList >

- < offeringData >

- < industryGroup >

< industryGroupType > Other Health Care </ industryGroupType >

</ industryGroup >

- < issuerSize >

< revenueRange > $1,000,001 - $5,000,000 </ revenueRange >

</ issuerSize >

- < federalExemptionsExclusions >

< item > 06 </ item >

</ federalExemptionsExclusions >

- < typeOfFiling >

- < newOrAmendment >

< isAmendment > false </ isAmendment >

</ newOrAmendment >

- < dateOfFirstSale >

< value > 2009-10-16 </ value >

</ dateOfFirstSale >

</ typeOfFiling >

- < durationOfOffering >

< moreThanOneYear > false </ moreThanOneYear >

</ durationOfOffering >

- < typesOfSecuritiesOffered >

< isOtherType > true </ isOtherType >

< descriptionOfOtherType > Convertible promissory note </ descriptionOfOtherType >

</ typesOfSecuritiesOffered >

- < businessCombinationTransaction >

< isBusinessCombinationTransaction > false </ isBusinessCombinationTransaction >

< clarificationOfResponse />

</ businessCombinationTransaction >

< minimumInvestmentAccepted > 2000000 </ minimumInvestmentAccepted >

- < salesCompensationList >

- < recipient >

< recipientName > NA </ recipientName >

< recipientCRDNumber > None </ recipientCRDNumber >

< associatedBDName > None </ associatedBDName >

< associatedBDCRDNumber > None </ associatedBDCRDNumber >

- < recipientAddress >

< street1 > NA </ street1 >

< street2 > NA </ street2 >

< city > NA </ city >

< stateOrCountry > XX </ stateOrCountry >

< zipCode > NA </ zipCode >

</ recipientAddress >

- < statesOfSolicitationList >

< state > MA </ state >

</ statesOfSolicitationList >

</ recipient >

</ salesCompensationList >

- < offeringSalesAmounts >

< totalOfferingAmount > 4250000 </ totalOfferingAmount >

< totalAmountSold > 2000000 </ totalAmountSold >

< totalRemaining > 2250000 </ totalRemaining >

< clarificationOfResponse />

</ offeringSalesAmounts >

- < investors >

< hasNonAccreditedInvestors > false </ hasNonAccreditedInvestors >

< totalNumberAlreadyInvested > 1 </ totalNumberAlreadyInvested >

</ investors >

- < salesCommissionsFindersFees >

- < salesCommissions >

< dollarAmount > 0 </ dollarAmount >

</ salesCommissions >

- < findersFees >

< dollarAmount > 0 </ dollarAmount >

</ findersFees >

< clarificationOfResponse />

</ salesCommissionsFindersFees >

- < useOfProceeds >

- < grossProceedsUsed >

< dollarAmount > 0 </ dollarAmount >

</ grossProceedsUsed >

< clarificationOfResponse />

</ useOfProceeds >

- < signatureBlock >

< authorizedRepresentative > false </ authorizedRepresentative >

- < signature >

< issuerName > SURGIVISION INC </ issuerName >

< signatureName > /s/ Oscar L. Thomas, Jr. </ signatureName >

< nameOfSigner > Oscar L. Thomas, Jr. </ nameOfSigner >

< signatureTitle > Vice President, Business Affairs </ signatureTitle >

< signatureDate > 2009-11-06 </ signatureDate >

</ signature >

</ signatureBlock >

</ offeringData >

</ edgarSubmission >