-----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, GK0IklTexJW/zJTsX6K9lFLV5i4u0V8NtsmMAtHbSsBKzKAuw/sgpZdsWrSButLd 3qAPK6wldc3e73m7HM95HQ== 0001209191-04-052788.txt : 20041115 0001209191-04-052788.hdr.sgml : 20041115 20041115173637 ACCESSION NUMBER: 0001209191-04-052788 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20041112 FILED AS OF DATE: 20041115 DATE AS OF CHANGE: 20041115 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Buck John D CENTRAL INDEX KEY: 0001289177 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18602 FILM NUMBER: 041147197 BUSINESS ADDRESS: BUSINESS PHONE: 952-992-2258 MAIL ADDRESS: STREET 1: 4201 GULF SHORE BLVD NORTH STREET 2: APT 1703N CITY: NAPLES STATE: FL ZIP: 34103 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ATS MEDICAL INC CENTRAL INDEX KEY: 0000824068 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 411595629 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3905 ANNAPOLIS LA STREET 2: SUITE 105 CITY: MINNEAPOLIS STATE: MN ZIP: 55447 BUSINESS PHONE: 6125537736 MAIL ADDRESS: STREET 1: 3905 ANNAPOLIS LANE STREET 2: SUITE 105 CITY: MINNEAPOLIS STATE: MN ZIP: 55447 FORMER COMPANY: FORMER CONFORMED NAME: ATS MEDCIAL INC DATE OF NAME CHANGE: 19920803 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2004-11-12 0 0000824068 ATS MEDICAL INC ATSI 0001289177 Buck John D 4201 GULF SHORE BLVD NORTH APT 1703 NORTH NAPLES FL 34103 1 0 0 0 Common Stock 2004-11-12 4 P 0 8800 4.24 A 8800 D Common Stock 2004-11-12 4 P 0 100 4.23 A 8900 D Common Stock 2004-11-12 4 P 0 1000 4.22 A 9900 D Common Stock 2004-11-12 4 P 0 100 4.20 A 10000 D Director Option (Right to Buy) 3.60 2005-05-02 2014-11-02 Common Stock 5000 5000 D Director Option (Right to Buy) 3.60 2005-11-02 2014-11-02 Common Stock 15000 15000 D Vests in 25% annual cumulative installments beginning this date. /s/ Deborah K. Chapman as Power-of-Attorney for John D. Buck 2004-11-15 EX-24.4_61521 2 poa.txt POA DOCUMENT POWER OF ATTORNEY Know all by these presents, that I hereby constitute and appoint each of Michael D. Dale and Deborah K. Chapman, my true and lawful attorney-in-fact and agent, each acting alone, with full powers of substitution for me and in my name, place and stead, to: 1. execute for me and on my behalf, in my capacity as an officer and/or director of ATS Medical, Inc., Forms 3, 4, and 5 in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended, and the rules promulgated thereunder; 2. do and perform any and all acts for me and on my behalf which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such Form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and 3. take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to me, in my best interest or legally required by me, it being understood that the documents executed by such attorney-in-fact on my behalf pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-facts discretion. I hereby grant to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as I might or could do if personally present, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-facts substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted. I acknowledge that the attorneys-in-fact named above, in serving in such capacity at my request, are not assuming, nor is ATS Medical, Inc. assuming, any of my responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended. This Power of Attorney shall remain in full force and effect until I am no longer required to file Forms 3, 4, and 5 with respect to my holdings of and transactions in securities of ATS Medical. Inc., unless earlier revoked by me in a signed writing delivered to the attorneys-in-fact named above. IN WITNESS WHEREOF, I have signed this Power of Attorney on November 4, 2004. Signature John D. Buck Print Name -----END PRIVACY-ENHANCED MESSAGE-----