0000897069-20-000035.txt : 20200115 0000897069-20-000035.hdr.sgml : 20200115 20200115161510 ACCESSION NUMBER: 0000897069-20-000035 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20200115 DATE AS OF CHANGE: 20200115 EFFECTIVENESS DATE: 20200115 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Fibroblast, Inc. CENTRAL INDEX KEY: 0001587278 IRS NUMBER: 455385914 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-358164 FILM NUMBER: 20528438 BUSINESS ADDRESS: STREET 1: 640 N. LASALLE DRIVE STREET 2: SUITE 200 CITY: CHICAGO STATE: IL ZIP: 60654 BUSINESS PHONE: (800) 396-6463 MAIL ADDRESS: STREET 1: 640 N. LASALLE DRIVE STREET 2: SUITE 200 CITY: CHICAGO STATE: IL ZIP: 60654 D 1 primary_doc.xml X0708 D LIVE 0001587278 Fibroblast, Inc. 640 N. LaSalle Drive Suite 200 CHICAGO IL ILLINOIS 60654 (800) 396-6463 DELAWARE None None Corporation true Scott Vold 640 N. LaSalle Drive Suite 200 Chicago IL ILLINOIS 60654 Executive Officer Director Kevin Weinstein c/o Fibroblast, Inc. 640 N. LaSalle Drive, Suite 200 Chicago IL ILLINOIS 60654 Director Jordan Dolin c/o Fibroblast, Inc. 640 N. LaSalle Drive, Suite 200 Chicago IL ILLINOIS 60654 Director Elias Pearson c/o Fibroblast, Inc. 640 N. LaSalle Drive, Suite 200 Chicago IL ILLINOIS 60654 Director Kirk Elder c/o Fibroblast, Inc. 640 N. LaSalle Drive, Suite 200 Chicago IL ILLINOIS 60654 Director Eric Alvarez 640 N. LaSalle Drive Suite 200 Chicago IL ILLINOIS 60654 Executive Officer Mark Luy 640 N. LaSalle Drive Suite 200 Chicago IL ILLINOIS 60654 Executive Officer Other Technology Decline to Disclose 06b false 2020-01-07 false true true true false 0 1000000 500000 500000 false 1 0 0 0 false Fibroblast, Inc. Scott Vold Scott Vold Chief Executive Officer and President 2020-01-15