-----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, RPiquv66PSQZm9JpcGpGqS2SCshS51v/Mt0kKZR9yLrqFrvjEOExbIjcALGaVnyO 4gYxnzXcv0H6r1vShGn2AQ== 0001047469-99-004302.txt : 19990211 0001047469-99-004302.hdr.sgml : 19990211 ACCESSION NUMBER: 0001047469-99-004302 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19990210 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: SC 13G SEC ACT: SEC FILE NUMBER: 005-33902 FILM NUMBER: 99527468 BUSINESS ADDRESS: STREET 1: ONE ALLENTOWN PARKWAY CITY: ALLEN STATE: TX ZIP: 75002 BUSINESS PHONE: 9723909800 MAIL ADDRESS: STREET 1: ONE ALLENTOWN PARKWAY CITY: ALLEN STATE: TX ZIP: 75002 FORMER COMPANY: FORMER CONFORMED NAME: QUEST MEDICAL INC DATE OF NAME CHANGE: 19920703 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: SAMS WILLIAM M CENTRAL INDEX KEY: 0001078947 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 326 MANTLEBROOK DRIVE CITY: DESOTO STATE: TX ZIP: 75115 MAIL ADDRESS: STREET 1: 326 MANTLEBROOK DRIVE CITY: DESOTO STATE: TX ZIP: 75115 SC 13G 1 SC 13G UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. )* ------ ADVANCED NEUROMODULATION SYSTEMS, INC. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock - -------------------------------------------------------------------------------- (Title of Class of Securities) 00757T101 ---------------------------------- (CUSIP Number) December 31, 1998 - -------------------------------------------------------------------------------- (Date of Event Which Requires Filing of this Statement) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: / / Rule 13d-1(b) / / Rule 13d-1(c) /X/ Rule 13d-1(d) *The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). CUSIP No. 000757T101 PAGE 2 OF 5 PAGES ---------- - ------------------------------------------------------------------------------- (1) Names of Reporting Persons. I.R.S. Identification Nos. of above persons (entities only). WILLIAM M. SAMS - ------------------------------------------------------------------------------- (2) Check the Appropriate Box if a Member (a) / / of a Group (See Instructions) (b) / / - ------------------------------------------------------------------------------- (3) SEC Use Only - ------------------------------------------------------------------------------- (4) Citizenship or Place of Organization United States - ------------------------------------------------------------------------------- Number of Shares (5) Sole Voting Power Beneficially 410,000 Owned by -------------------------------------------------- Each Reporting (6) Shared Voting Power Person With: 0 -------------------------------------------------- (7) Sole Dispositive Power 410,000 -------------------------------------------------- (8) Shared Dispositive Power 0 - ------------------------------------------------------------------------------- (9) Aggregate Amount Beneficially Owned by Each Reporting Person 410,000 - ------------------------------------------------------------------------------- (10) Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) / / - ------------------------------------------------------------------------------- (11) Percent of Class Represented by Amount in Row (9) 5.4% - ------------------------------------------------------------------------------- (12) Type of Reporting Person (See Instructions) IN - ------------------------------------------------------------------------------- 2 CUSIP No. 000757T101 PAGE 3 OF 5 PAGES ---------- ITEM 1. (a) Name of Issuer Advanced Neuromodulation Systems, Inc. --------------------------------------------------------------------- (b) Address of Issuer's Principal Executive Offices One Allentown Parkway, Allen, Texas 75002 --------------------------------------------------------------------- ITEM 2. (a) Name of Person Filing William M. Sams --------------------------------------------------------------------- (b) Address of Principal Business Office or, if none, Residence 326 Mantlebrook Drive, DeSoto, Texas 75115 --------------------------------------------------------------------- (c) Citizenship United States --------------------------------------------------------------------- (d) Title of Class of Securities Common Stock --------------------------------------------------------------------- (e) CUSIP Number 00757T101 --------------------------------------------------------------------- ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO SECTIONS 240.13d-1(b) OR 240.13d-2(b) OR (c), CHECK WHETHER THE PERSON FILING IS A: (a) / / Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o). (b) / / Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c). (c) / / Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c). (d) / / Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8). (e) / / An investment adviser in accordance with section 240.13d-1(b)(1)(ii)(E). (f) / / An employee benefit plan or endowment fund in accordance with section 240.13d-1(b)(1)(ii)(F). (g) / / A parent holding company or control person in accordance with section 240.13d-1(b)(1)(ii)(G). (h) / / A savings association as defined in section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813). (i) / / A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3). (j) / / Group, in accordance with section 240.13d-1(b)(1)(ii)(J). If this statement is filed pursuant to Rule 13d-1(c), check this box. / / CUSIP No. 000757T101 PAGE 4 OF 5 PAGES ---------- ITEM 4. OWNERSHIP Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1. (a) Amount beneficially owned: 410,000 --------------------------------------------------------------------------- (b) Percent of class: 5.4% --------------------------------------------------------------------------- (c) Number of shares as to which the person has: (i) Sole power to vote or to direct the vote 410,000 ----------------------------------------------------------------- (ii) Shared power to vote or to direct the vote 0 ----------------------------------------------------------------- (iii) Sole power to dispose or to direct the disposition of 410,000 ----------------------------------------------------------------- (iv) Shared power to dispose or to direct the disposition of 0 ----------------------------------------------------------------- ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following. / / ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON Not Applicable ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY Not Applicable ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP Not Applicable ITEM 9. NOTICE OF DISSOLUTION OF GROUP Not Applicable ITEM 10. CERTIFICATION (a) Not Applicable (b) Not Applicable 4 CUSIP No. 000757T101 PAGE 5 OF 5 PAGES ---------- SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. February 9, 1999 ---------------------------------------- Date /s/ William M. Sams ---------------------------------------- Signature William M. Sams ---------------------------------------- Name/Title -----END PRIVACY-ENHANCED MESSAGE-----